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The goal of this presentation is to understand what the appeal process means; review claim appeal guidelines and requirements for Medicare and some of the most common commercial payers, such as Aetna, Cigna, Carefirst, and United Healthcare; review what attachments are needed for the appeal, and how to set protocols for successful follow-up of denied claims.

Learning Objectives:

• To review what the appeal process means.
• To review the life of the claim.
• To understand the timing when an appeal is appropriate.
• To review claim appeal guidelines for Medicare.
• To review claim appeal guidelines for some of the most common commercial payors, such as Aetna, Cigna, Carefirst, and United Healthcare.
• To understand what attachments are needed for appeal
• To discuss ways how to set protocols for successful follow-up of denied claims.

Areas Covered in the Session

• Review of the appeal process.
• Review of the life of the claim.
• Review and understand the timing when an appeal is appropriate.
• Review claim appeal guidelines for Medicare.
• Go over examples of appealed scenarios for Level 1 and 2 Medicare appeals.
• Review claim appeal guidelines for some of the most common commercial payers, such as Aetna, Cigna, Carefirst, and United Healthcare.
• Go over examples of appealed scenarios for commercial payer appeals.
• Understand what attachments are needed for appeal.
• Go over ideas on how to set protocols for successful follow-up of denied claims.

Suggested Attendees

• Medical providers, who are involved in the payment process of their practice
• Physicians
• Practice Managers
• Billing Managers
• C-level Executives
• Office Managers
• Medical Billers
• Medical Coders
• Office staff and Billing Managers
• Medical Billing Companies
• Providers’ Office Staff
• Hospital Revenue Cycle Staff

About the Presenter