January 8, 2013

Greetings {ContactName|Appeal Letter Subscriber},

The 60-Day Appeal Review Standard: Getting Carriers To Answer Appeals

Appeal review deadlines vary from plan to plan and payer to payer.  However, there are appeal deadlines applicable to most claims.  We have developed appeal letters to assist you with citing the appeal review deadline applicable to many carriers. . . .

Continue reading this article at AppealLettersOnline.com

AppealLettersOnline.com Featured Letters

The Appeal Letters template featured above has been added to the AppealLettersOnline.com database under the category Stalled Claims and the subcategory Appeal Response Deadlines.  The letters is titled URAC Claim Processing Standards

Several state-specific letters in this category have been updated this month:

  • California Appeal Response Deadline

  • Hawaii Appeal Response Deadline

  • South Dakota Appeal Response Deadline

Access the appeal letters at AppealLettersOnline.com


Using Utilization Review Laws To Appeal And Obtain Quality Appeal Reviews

We have developed an appeals training program specifically for utilization review personnel.  Using Utilization Review Laws to Appeal Denials and Obtain Quality Appeal Review is a 90-minute presentation specific to state and federal utilization review laws.  Tammy Tipton, President of Appeal Solutions, will discuss how to assert your rights when insurers deny medically necessary care.  Level I and Level II utilization review appeal tactics will be discussed and legal protections related to specialty care peer review will be explained.  Some of the appeal letters to be discussed include the following:

  • State time frames for initial decision

  • State time frames for appeal review

  • Demanding specialty care and subspecialty care peer review

  • State medical necessity laws and peer review disclosure requirements

  • Getting action on unnecessarily stalled decisions

  • How to make sure a precertification is honored

Sample appeal letters are part of the course material and can by customized for your specialty.  Please call Tammy Tipton at 888-399-4925 ext 703 to obtain a training quote and schedule the presentation for your staff.

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