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Provider Disputes and Appeals: Best Practices for Health Plans

Event Date:4/23/2019

Event Overview

Tuesday, April 23, 2019
1:00 PM CT – 2:00 PM CT (60 minutes)
Hosted by: Physicians Health Plan

This event is hosted on our ReadyTalk platform

 

Physicians Health Plan shares their provider appeals process which has served them well for over 10 years. Members will engage in lively discussion about their own challenges around handling provider disputes on claims, and ways they have reduced the incidence of appeals through education and other means. Join us to hear about best practices for dispute resolution.

Audience

Those involved in claims management and processing.


Ask your peers a question or share a resource anytime through the Alliance discussion forum

You can visit the discussion forum and post a question anytime. It's only available to Alliance members, so you question is private and secure. When submitting a question, you can select which topics your question is related to, such as "risk adjustment" or "coding". Individuals who have indicated in their Alliance profile they are interested in those topics and are opted in to discussion forum emails will receive your question. You can also add an attachment to your question or reply, making this tool another great resource for sharing best practices with your peers.

 


 

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Documents
Attendees

Below is a list of all delegates registered to date for this event

  • Carrie Abenante
  • ALLIANCE MEMBER
  • Manager, Special Investigations Unit at Sentara Health Plans (Optima)
  • Olamide Akanbi
  • ALLIANCE MEMBER
  • Regulatory Coordinator at Paramount Health Care
  • Sandi Bascove
  • ALLIANCE MEMBER
  • Provider Relations Manager at Health New England
  • Stephanie Belue
  • ALLIANCE MEMBER
  • Manager of Quality Assurance, RIsk Management, and Training at Alliant Health Plans
  • Lisa Boucher
  • ALLIANCE MEMBER
  • Accreditation Program Manager at Network Health
  • Katrina Briguglio
  • ALLIANCE MEMBER
  • Operations Director(Claims) at Health First Health Plans
  • Virginia Burford
  • ALLIANCE MEMBER
  • Claims Supervisor, Health One Alliance at Alliant Health Plans
  • Allen Chen
  • ALLIANCE MEMBER
  • Director of Network Operations at Central Health Plan of California
  • Martha Cisneros
  • ALLIANCE MEMBER
  • Member Services Manager at Valley Health Plan
  • Serena Clark
  • ALLIANCE MEMBER
  • Network Liaison at HealthTeam Advantage
  • Emily Corley
  • ALLIANCE MEMBER
  • QI Program Specialist at CommunityCare
  • Jacqueline Crews
  • ALLIANCE MEMBER
  • Director, Government Programs & Regulatory Affairs at AvMed
  • Crystal Djordjevic
  • ALLIANCE MEMBER
  • Risk Adjustment Coding Consultant at Health Alliance Medical Plans
  • Phyllis Fisher
  • ALLIANCE MEMBER
  • Director, Operations at Physicians Health Plan
  • Damaris Gautier
  • ALLIANCE MEMBER
  • Medical Director - Office of the CMO at Scott & White Health Plan
  • Loriann Heinssen
  • ALLIANCE MEMBER
  • Director of HFHP Compliance at Health First Health Plans
  • Marjorie Henriksen
  • ALLIANCE MEMBER
  • Director of Operations, Prominence Heatlh Plan/CDS Group Health at Prominence Health Plan
  • Freda Hogan
  • ALLIANCE MEMBER
  • VP Network Development at Health Alliance Plan (HAP)
  • Nancy Johnson
  • ALLIANCE MEMBER
  • VP, Compliance & Regulatory Affairs at Community Health Options
  • Cindy Jorgensen
  • ALLIANCE MEMBER
  • Director of Medicaid Programs at Scott & White Health Plan
  • Tina Korty
  • ALLIANCE MEMBER
  • Vice President of Legal, Compliance, and Regulatory at Indiana University Health Plans
  • Cassie Lane
  • ALLIANCE MEMBER
  • Associate-Senior Claims Coding at Indiana University Health Plans
  • Doris Livingston
  • ALLIANCE MEMBER
  • Manager, Customer Service Government Programs at Sentara Health Plans (Optima)
  • Jessica Lopez
  • ALLIANCE MEMBER
  • Provider Support Supervisor at Care N' Care Insurance Company, Inc.
  • Angie Lovell
  • ALLIANCE MEMBER
  • Operations Manager at Prominence Health Plan
  • Greta Matus
  • ALLIANCE MEMBER
  • FWA Special Investigator at Health Alliance Medical Plans
  • Millie McConnell
  • ALLIANCE MEMBER
  • Claims Analyst III at Indiana University Health Plans
  • Margie McNett
  • ALLIANCE MEMBER
  • VP - General Counsel - Health Plan Operations at Presbyterian Health Plan
  • Amy Meldeau
  • ALLIANCE MEMBER
  • Appeal and Grievance Manager at Health First Health Plans
  • Janna Miller
  • ALLIANCE MEMBER
  • Operations Claims Manager at Health First Health Plans
  • Daniel Morrissey
  • ALLIANCE MEMBER
  • Assistant Coordinator at Paramount Health Care
  • Sandra Nary
  • ALLIANCE MEMBER
  • Clinical Auditor at Neighborhood Health Plan of Rhode Island
  • Wendy Owen
  • ALLIANCE MEMBER
  • Sr. Fraud & Abuse Investigator at Sentara Health Plans (Optima)
  • Joyce Petermann
  • ALLIANCE MEMBER
  • Coding validator/risk adjustment specialist at Avera Health Plans (DAKOTACARE)
  • Dipali Portwood
  • ALLIANCE MEMBER
  • Lead Compliance Auditor at Scott & White Health Plan
  • Julie Powell
  • ALLIANCE MEMBER
  • Investigator at Sentara Health Plans (Optima)
  • Annie Shieh
  • ALLIANCE MEMBER
  • Senior Compliance Counsel at Central Health Plan of California
  • Jeanne Skinner
  • ALLIANCE MEMBER
  • Manager, Payment Integrity & Recovery at Network Health
  • Donna Sossamon
  • ALLIANCE MEMBER
  • Appeals and Grievance Specialist at Alliant Health Plans
  • Leslie Sprites
  • ALLIANCE MEMBER
  • Director of Claims at Alliant Health Plans
  • Sara Stiles
  • ALLIANCE MEMBER
  • Manager at Sentara Health Plans (Optima)
  • Jill Stoken
  • ALLIANCE MEMBER
  • Contract & Provider Relations Manager at Network Health
  • David Stuart
  • ALLIANCE MEMBER
  • Director, Claim Operations at Community Health Options
  • Debra Tracy
  • ALLIANCE MEMBER
  • Senior Business Analyst at Health First Health Plans
  • Bhargavi Vemuri
  • ALLIANCE MEMBER
  • Manager, Claims Quality at Indiana University Health Plans
  • Elizabeth Waite
  • ALLIANCE MEMBER
  • Manager, Appeals & Grievances at Network Health
  • Kimberly Walker
  • ALLIANCE MEMBER
  • Clinical Operations Manager at Care N' Care Insurance Company, Inc.
  • Rebecca Welling
  • ALLIANCE MEMBER
  • Director Coding Compliance at Providence Health Plans
  • Jered Wilson
  • ALLIANCE MEMBER
  • Chief Operating Officer at Paramount Health Care
Speakers