Discussion on ERISA claim processing regulations and the latest court decisions which support the providers who are demanding better reviews by payers. Attendees will gain knowledge on federal claim processing guidelines, what type of claims fall under the guidelines, what to do when noncompliance is detected and how courts are ruling on recent cases.

Do you submit well-worded appeals you suspect are not carefully reviewed by the payers? Are you ready to join the healthcare providers who have officially called the Provider Appeal Process a “FAKE” appeal process?

Tammy Tipton, President of Appeal Solutions, will discuss ERISA claim processing regulations and the latest court decisions which support the providers who are demanding better reviews by payers. Attendees will gain knowledge on federal claim processing guidelines, what type of claims fall under the guidelines, what to do when noncompliance is detected and how courts are ruling on recent cases.

Participants will receive 10 ERISA appeal letter templates to make it easy to submit well-worded demands for quality review.

This session will provide you with the knowledge to:

• Which healthcare organizations refer to the Provider Appeal Process as a “FAKE” appeal process and why. Plus, how to cite ERISA regulatory information to demand high quality medical necessity review
• Timely ERISA appeal submission and how to seek compliance with ERISA appeal decisions by payers
• Asserting your ERISA rights with insurers including your right to demand benefit information prior to treatment
• What to do with standard form letter responses and what courts have identified as irresponsible and non-compliant review processes
• Using attachments to make your appeal stronger while also making payers expend additional resources on review