Audio Conferences

Audioconference Title:  Denial Management & ERISA Appeals:  Best Practices.

Audioconference Objective:  ERISA claim processing regulations and disclosure requirements can be utilized at several key phases of the revenue cycle. Knowledge of ERISA assists admission and precertification staff with obtaining accurate, timely insurance verification and claim approval. Further, tracking carrier noncompliance with ERISA regulations can improve collections and enhance success on appeals.

Attendees will gain knowledge on federal claim processing guidelines, what type of claims fall under the guidelines and what to do when noncompliance is detected. This information will assist with reaching both collection goals and enhance denial management. Sample appeal letters will be distributed as well as a compliance tracking tool to allow better assessment of carrier compliance with ERISA.

Key areas to be covered include:

  • How to identify ERISA claims
  • How to use ERISA in the verification and case management/UR departments
  • Provider appeal rights under ERISA and enhancing those protections
  • Specific application of ERISA regulations on timely filing, verification and medical necessity appeals
  • How to appeal to the entity with authority on ERISA claims
  • Managed care contract provisions which mimic ERISA protections

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