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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
4/29/2019

Recording: Provider Disputes and Appeals: Best Practice for Health Plans
Physicians Health Plan shares their provider appeals process which has served them well for over 10 years.

4/22/2019

Presentation: Provider Disputes and Appeals Webinar
Physicians Health Plan shares their provider appeals process which has served them well for over 10 years.

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)
  • Sandi Bascove
  • ALLIANCE MEMBER
  • Provider Relations Manager at Health New England
  • Stephanie Belue
  • ALLIANCE MEMBER
  • Director of Quality Assurance & Privacy Officer at Alliant 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
  • Director, Member Outreach & Engagement at Valley Health Plan
  • Jacqueline Crews
  • ALLIANCE MEMBER
  • Director, Public Policy & Benefit Contracts at AvMed
  • Crystal Djordjevic
  • ALLIANCE MEMBER
  • Risk Adjustment Education Specialist at Health Alliance Medical Plans
  • Phyllis Fisher
  • ALLIANCE MEMBER
  • Director, Operations at Physicians Health Plan
  • Lori Heinssen
  • ALLIANCE MEMBER
  • Director Appeals and Grievances at Health First Health Plans
  • Tina Korty
  • ALLIANCE MEMBER
  • Vice President, Health Plans Legal, Compliance & Regulatory at IU Health Plans
  • Cassie Lane
  • ALLIANCE MEMBER
  • Associate-Senior Claims Coding at IU Health Plans
  • Jessica Lopez
  • ALLIANCE MEMBER
  • Operations Manager at Care N' Care Insurance Company, Inc.
  • Angie Lovell
  • ALLIANCE MEMBER
  • Director of Operations at Prominence Health Plan
  • Margie McNett
  • ALLIANCE MEMBER
  • VP - General Counsel - Health Plan Operations at Presbyterian Health Plan
  • Amy Meldeau
  • ALLIANCE MEMBER
  • Director of Product Development and Governance at Health First Health Plans
  • 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)
  • Charles Palermo
  • ALLIANCE MEMBER
  • Vice President, Claim Services at Health Alliance Plan (HAP)
  • Julie Powell
  • ALLIANCE MEMBER
  • Investigator at Sentara Health Plans (Optima)
  • Jasmin Rabsatt
  • ALLIANCE MEMBER
  • Compliance Manager at Sentara Health Plans (Optima)
  • Annie Shieh
  • ALLIANCE MEMBER
  • Sr. Director of Compliance, CA Compliance Officer at Central Health Plan of California
  • Jeanne Skinner
  • ALLIANCE MEMBER
  • Manager, Appeals & Grievance at Network Health
  • Donna Sossamon
  • ALLIANCE MEMBER
  • Appeals and Grievance Specialist at Alliant Health Plans
  • Leslie Sprites
  • ALLIANCE MEMBER
  • Senior 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
  • Dave Stuart
  • ALLIANCE MEMBER
  • Senior Vice President & Chief Operating Officer at Community Health Options
  • Bhargavi Vemuri
  • ALLIANCE MEMBER
  • Manager, Claims Quality & HCC Operations at IU Health Plans
  • Kimberly Walker
  • ALLIANCE MEMBER
  • Clinical Operations Manager at Care N' Care Insurance Company, Inc.
Speakers