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• Training Courses
  • Benefit Disclosure
    • Lesson 1: Benefit Disclosure and Appeals Regarding Misquoted Benefits
    • Lesson 2: Registration Data Quality and related Appeals
    • Lesson 3: Protecting Your Verification Efforts
    • Lesson 4: Demanding Benefit Clarification Disclosure
    • Lesson 5: How To Use the Pretreatment Disclosure Request
  • Contract Negotiation
    • Lesson 1: Managed Care Negotiation
    • Lesson 2: Negotiating Medical Necessity Contractual Protections
  • ERISA
    • Lesson 1: Understanding the ERISA Effect
    • Lesson 2: The ERISA Claims Procedure Regulation
  • Incorrect Payments & Deductions
    • Lesson 1: Incorrect Payment Appeals
    • Lesson 2: Demanding Disclosure of Fee Schedule and/or Benefit Calculation
    • Lesson 3: Appealing Claims With Modifiers
  • Medical Necessity
    • Lesson 1: An Ill-Defined Term
    • Lesson 2: What Goes Wrong With Medical Necessity Review
    • Lesson 3: Medical Necessity Appeal Component 1: Summarize the Patient’s Care
    • Lesson 4: Medical Necessity Appeal Component 2: Cite Regulatory and/or Compliance Information
    • Lesson 5: Medical Necessity Appeal Component 3: Demand Disclosure of Payer’s Denial Basis
    • Lesson 6: ERISA Medical Necessity Decisions
  • Medicare
    • Lesson 1: Internal Medicare Compliance Oversight
    • Lesson 2: Medicare Appeals Process
    • Lesson 3: Geriatric Treatment And Medical Necessity Issues
  • Prompt Pay
    • Lesson 1: State Prompt Payment Laws
    • Lesson 2: ERISA Prompt Payment
    • Lesson 3: Workers’ Compensation Prompt Payment Law
  • Providers’ Rights
    • Lesson 1: Providers’ Right To Access A Quality Appeal Process
    • Lesson 2: Providers’ Right to Pursue Appeal Without Reprisal From Carrier
    • Lesson 3: Providers’ Right to Litigate
    • Lesson 4: Providers’ Right to appeal and/or Act as Authorized Representative
  • Refund & Recoupments
    • Lesson 1: Identifying Incorrect Payments and Potentially Applicable Laws
    • Lesson 2: Contest A Refund/Recoupment
  • Specialty Care
    • Lesson 1: Specialty Care Appeals
    • Lesson 2: Alternative/Complementary Care
    • Lesson 3: Mental Health
    • Lesson 4: Emergency Care
    • Lesson 5: Obstetrics-Gynecology
  • Treatment Exclusions/Limits
    • Lesson 1: Coverage Termination
    • Lesson 2: Experimental Treatment Appeals
    • Lesson 3: Maximum Benefit Appeals
    • Lesson 4: Preexisting Conditions
    • Lesson 5: Timely Filing Limitations
    • Lesson 6: Treatment Caps
  • Utilization Management
    • Lesson 1: Utilization Management Appeals
    • Lesson 2: Review and Use of State Utilization Review mandates including Peer Discussion
    • Lesson 3: Health Utilization Management Accreditation Standards
    • Lesson 4: Tracking Preauthorization Response Compliance
• Webinars