Different Payers Mean Different Appeal Strategies

So often the answer to ‘How do I appeal this or that?” depends on the answer to “Who is the payer and do you have a contract?” Join us as we discuss the variability in the appeals process based on payers and payer contracts.

At the conclusion of the webinar, the learner will be able to:

Describe the essential differences in appeal processes based on payer, contract, and appellant.

At conclusion of the webinar, at least 90% of participants will share on the evaluation:

  1. The ability to identify 2 opportunities to move through the 5-level Medicare appeals process when the payer is a Medicare Advantage plan
  2. The ability to identify what type of form is required for a provider to appeal on behalf of a patient
  3. The ability to identify the payer’s timeframes for appeal

About the presenters:

Denise Wilson MS, RN, RRT

President | Association for Healthcare Denial and Appeal Management

Senior Vice President | PayerWatch – AppealMasters

Denise serves as the Senior Vice President at PayerWatch – AppealMasters. Denise is also President of The Association for Healthcare Denial and Appeal Management. Denise is a Registered Respiratory Therapist, Registered Nurse, and holds a master’s degree in Management Information Systems from the University of Illinois, Springfield. Denise has over thirty years of experience in healthcare, including clinical management, education, compliance, and appeal writing.

Denise has extensive experience as a Medical Appeals Expert and has personally managed hundreds of Medicare, Managed Medicare, and Commercial appeal cases and presented hundreds of cases at the Administrative Law Judge level. Denise is a nationally known speaker and dynamic educator on Medicare and Commercial appeals processes, payer behaviors, standards of care, appeal template development, and building a road map to drive the payer to a decision in the provider’s favor. She has educated thousands of healthcare professionals around the country in successfully overturning medical care denials. Denise’s special area of expertise is in writing and producing successful appeals.