eNewsletter: Reimbursement eNewsletter for the healthcare community

ISSUE 66 Mar 9, 2010


















Getting Duplicate Claim Denials on Rebilled Claims?
You bill the claim. No response. You rebill the claim. This time, you get a response – a duplicate claim denial. Yes, you are still in the dark regarding what action was taken on the initial claim. Even worse, you spend 45 minutes on the phone only to find out that customer service can only access the most recent submission. . . . Read this article >>
AppealLettersOnline Featured Letters
In addition to the Duplicate Claim appeal letter referenced above, Appeal Solutions added the following state-specific letters to the repository:

  • Hawaii Disclosure law (new letter)
  • Hawaii Utilization Review Requirements (new letter)
  • Hawaii Verification of Benefits
Access these letters >>
50 Texas Appeal Letters & How To Use Them Like A Pro
Appeal Solutions has developed an appeals training program specifically for Texas medical billers. 50 Texas Appeals Letters & How to Use Them Like A Pro is a three hour presentation specific to Texas insurance claim review laws. Tammy Tipton, President of Appeal Solutions, will discuss how to assert your rights when insurers deny or underpay medical claims. 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
  • State and/or federal laws related to specialty care including access to care, peer review, direct access and clinical trial coverage and how to demand compliance with mandatory coverage laws.
  • Coding appeals and demanding a review by a specialty coder and release of coding criteria.
  • Getting action on unnecessarily stalled claims and incorrect payment including UCR, Silent PPO and contractual denials
  • Seven tips to improve medical necessity denials
  • Maximum Benefit Appeals and
  • How To Respond to Refund/Recoupment Response letters.

Cost of the presentation is $3,000 plus hotel and transportation expenses for your area. Training includes 50 appeal letters customized for the client’s specific denial issues. This presentation is only available at this rate from March 29 to May 15.