Navigating Medicare Advantage and MCO requirements can be challenging—especially when authorizations, claim determinations, and retroactive changes in patient benefits are involved.
In this workshop with Amy Fulton (Vice President, FGA Receivables Management, Inc.) we’ll examine the federal and state requirements governing authorization requests and claim payment, including situations in which a patient’s benefits change retroactively, including when the patient elects a non-par plan.
You’ll learn what providers should do when an insurance:
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Fails to respond to an authorization or claim within the timeframe required by CMS
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Denies or delays payment following a retroactive change in benefits
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Does not follow applicable federal or state regulations
You’ll walk away with practical tools and strategies to navigate the authorization and billing process, exercise your provider rights, and pursue payment when retroactive coordination of benefits creates challenges.
Join us virtually to learn how to advocate effectively for your practice—and what steps to take when an insurance doesn’t meet its obligations.