Learn a key way hospitals can strengthen their appeals processes with payers using strategies from University of California Health.
What strategies have been successful for you when working with payers?
Evan Martin: “Strategies that we've been using are really to be partnering with payers and then also countering them back (when we detect a denial trend or new type of denial). We’re really being able to take the policy information and we’re comparing that to our contract terms and seeing whether we already have carve-out language that prohibits the health plan from implementing that policy with us.
“And then we're doing a rebuttal, we’re responding back to them by taking pre-financial analytic data and going through and saying, ‘Okay, if this policy is X, how much of that's going to be a financial impact back to our organization as a whole?’ And then from there, converting that and our appeal letter back to them. Once we've submitted that letter, we are then attaching that letter to future appeals to the organization to prevent them from being able to say, ‘Well, you never notified us.’ And it's been part of our appeal process for future appeal attachments.”
