Redeterminations FYI

Description of the Problem

Due to an unusually high volume of written appeal requests there is currently a delay in the processing of appeals.

What This Means to You

Our Appeals Department is working diligently to remain within the specified time frame to process your appeal. If you have submitted an appeal within the last 60 days and have not received any correspondence, please be patient. We request that you not resubmit your claims as this may cause further delays in processing your appeal request.

Current Status of Problem

[UPDATE] 08/04/14: The majority of the redetermination inventory was received between 04/07/14 – 05/27/14. A small percentage of redetermination requests were filed prior to this date range. If you are seeking information on one or more of these older requests, contact the Provider Call Center for further research and prioritized resolution. Please watch for Email Updates and the Latest Production Alerts section of our website for information on the status of this issue.

Trizetto 99% Club Accomplishment

June ended with terrific news. At month end we were notified by Trizetto that we had 7 providers reach the 99% club. Most of these clients have reached the 99% club multiple times, but we have one HUGE success we would like to share this month…

We have received a 'purple sticker of excellence' from Gateway (Trizetto) for having under 1% of rejections for the last quarter. Currently, we have accomplished this goal for the last 8 consecutive months. This is HUGE! This means that 99% of the claims we are submitting to Gateway are ERROR FREE!

Clients that achieve this 'Gold Standard of Revenue' are highlighted in newsletters and external press, and asked to share their successes for publication.

Complete Practice Solutions is working hard for our clients, and it shows when 99% of our claims are going out clean the first time!

A Roadmap to Better Care for Medicare Patients

Medicare has released an awesome document walking patients through the appropriate steps to get the most of your healthcare. This a very useful tool to give out to patients or point them in the direction of. To view this easy to follow pdf online click here. Educated patients lead to successful practices!