eNewsletter: Reimbursement eNewsletter for the healthcare community

ISSUE 65 Feb 9, 2010




















Getting Around the Clean Claims Cop-out: Appealing Claim Deficiency Denials
Are your payers getting around prompt payment requirements using the clean claim cop-out? Although prompt payment is not tightly regulated on state and federal levels, many carriers avoid prompt payment by requiring claim detail above and beyond the standard identifying information.  Particularly troublesome are carriers that. . . . Read this article >>
AppealLettersOnline Featured Letters
Appeal Solutions has a number of appeal letters specific to appealing ERISA claims. Please see the following letters:

Topic: Stalled Claims

  • ERISA Timely Pay Statute
  • ERISA Clean Claim
Topic: Medical Necessity
  • ERISA Concurrent Review
  • ERISA Request for Expert Review
  • ERISA Review Procedure
  • ERISA Urgent Precert Request
Access these letters >>
15 ERISA Appeal Letters & How To Use Them Like A Pro
Appeal Solutions has developed an appeals training program specifically addressing ERISA protections. 15 ERISA Appeals Letters & How to Use Them Like A Pro is a three hour presentation specific to appealing ERISA health care claim denials.  Tammy Tipton, President of Appeal Solutions, will discuss how to assert your rights when insurers deny or underpay ERISA. Level I and Level II appeal responses will be discussed and legal protections related to appeal review will be explained. Some of the appeal letters to be discussed include the following:
  • Incorrect verification of benefits
  • ERISA protections related to timely payment, access to care, expert review, disclosure of plan documents and how to demand compliance with ERISA protections by appealing to plan fiduciaries.
  • Coding appeals and demanding a review by a specialty coder and release of coding criteria.
  • Getting action on unnecessarily stalled claims.
  • Maximum Benefit Appeals and
  • How To Respond to Refund/Recoupment Response letters.

Cost of the presentation is $2500 plus airfare, hotel and transportation expenses for your area. Training includes appeal letters customized for  your practice’s specific denial issues.