Obtaining Authorization While Patient Is In House
June 29, 2022 4:52 pmMYTH: MA Plans are not required to respond to an inpatient authorization request. FACT: MA Plans ARE required to respond to an inpatient authorization... View Article
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Community Rallies Around Yorba Linda Teen in Need of Operation
April 6, 2019 5:57 pmERN in the news! This morning, I saw this piece aired by Channel 5 of a young boy we successfully... View Article
How to Challenge Improper Denials of Emergency and Post-Stabilization Services
December 4, 2018 11:00 amINTRODUCTION As a provider in the acute medical setting, you have undoubtedly experienced the difficulty in obtaining prompt reimbursement for... View Article
Can an HMO make a medical decision without looking at medical records?
February 27, 2018 10:31 amSometimes you are the only thing that stands between the single crushing blow of HMO and a patient or provider.... View Article
24 Hour UM Access
December 8, 2017 12:14 am“Hello, you have reached the UM Department. We are open Monday through Friday, 8 a.m. to 5 p.m. Please leave... View Article
Monarch Healthcare
May 16, 2017 5:40 pmERN/TRAF wins treatment for a 16 year old student-athlete in one (1) week. View and download TRAF’s patient case study... View Article
CASE STUDY: HMO Medical Necessity
October 6, 2016 9:50 pmCASE BACKGROUND: A 16 year old student-athlete suffered a PCL grade 2 partial tear, has knee instability due to ligament... View Article
CalPERS DENIES AUTHORIZED MEDICAL CARE FOR DECEASED MEMBER
September 23, 2016 9:54 am“Justice will not be served until those who are unaffected are as outraged as those who are.” – Benjamin Franklin... View Article
VHA CLAIMS PAYMENT BACKLOG CONTINUES: TIME IS OF THE ESSENCE
March 10, 2016 6:22 pmNever leave that till tomorrow which you can do today. Benjamin Franklin. One of the most exposed issues within... View Article
DO IT….OR ELSE: WHY IS THE VETERANS HEALTH ADMINISTRATION REQUIRING AMBULANCE PROVIDERS TO SUBMIT HOSPITAL RECORDS?
January 6, 2016 7:22 pmAs we express our gratitude, we must never forget that the highest appreciation is not to utter words, but to... View Article