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How the Affordable Care Act Supports Denied Health Insurance Claims
Since the June, 2012 Supreme Court decision reaffirming the constitutionality of the Patient Protection and Affordable Care Act (aka Obamacare), most of the discussion has centered squarely around the individual mandate which makes everybody buy in. That’s all part of the affordable part. But that first part is important too. Protection, how does that work…
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Frequently Asked Questions About Claim Services and Denied Medical Claims Help
Q. What is the role of the advocate?A: The advocate provides denied medical claims help to ensure that you get every penny of what is due you. What insurance companies won’t tell you, we will. We are on your side. Q. How much will it cost?A: As a 501(c)3 non-profit, there is no charge…
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Basic Steps to Avoid Insurance Denials When Preparing Medical Claims
Best Practices – Insureds Prepare the Claim 1. Understand your health insurance – Read your plan coverage booklet when your body and mind are healthy. Don’t wait until you’re too sick to understand your coverage. It only adds to your stress. This may sound obvious, but you’d be surprised how many people don’t know how much they…
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Preparing Medical Claims for Appeal Before Submission
Prepare Providers The passage of the 2010 healthcare reform meant fundamental changes to medical claim appeal preparation that providers need to be aware of and follow when preparing to appeal a mispaid claim. Depending on whether the patient is insured under a fully-funded or self-funded healthcare plan, different laws regulate the appeal process. For fully-funded health plans, the…
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Overview of the Health Insurance Appeal Process and How to Prepare Appeal Letters
Appeal The passage of the 2010 healthcare reform meant fundamental changes to medical claim appeal preparation that providers need to be aware of and follow when preparing to appeal a mispaid claim. Depending on whether the patient is insured under a fully-funded or self-funded healthcare plan, different laws regulate the appeal process. For fully-funded health plans, the appeals process eventually…
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Understanding the Internal Appeal Process After Health Insurance Claim Denial
Internal Appeal Providers An internal appeal is a first request to have a claim reconsidered after the health insurance company denied it. It is usually conducted “in-house” using the healthplan’s clinical reviewers. Some plans now outsource their internal appeals to an independent review organization (IRO). Internal appeals for fully-insured plans are self-regulated by the health plan. On…
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Medical Claim Submission Strategies for Accurate Filing
Claim Submission Tools Providers Knowing how to submit a medical claim correctly is imperative because the practice’s revenue cycle begins — and sometimes ends with a denial — here. Carefully review your practice’s current claims processing systems: Segregate the percentage of claims submitted within the last 30 days that were delayed, rejected or denied…
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Deep Inside a Claim Denial Factory Part 3
The following is an expression the right to Free Speech, protected under the First Amendment of the Constitution of The United States of America. It is the opinion and property of the author and is for entertainment purposes only. As such it should not be considered actionable by any parties mentioned herein. “I did…
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Understanding Unexplainable Medical Claim Denials and Their Causes
The following is an expression of free speech rights protected under the First Amendment of the Constitution of The United States of America, It is the opinion and property of the author and is for entertainment purposes only. As such, it should not be considered actionable by any parties mentioned herein. Step right…
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2012 Improvements in Medical Claims Processing
“Staggering Quality Improvement In One Year. Really… Ever since the beginning of health insurance in the U.S., a certain tension has existed between doctors and health insurers. It can be argued that it’s because their relationship is fundamentally contentious in that providers have performed a service for which they expect to be paid, and health insurers…