Phase II: Claims Appeals

  • Know your appeal rights, and appeal tactically
  • Exercise efficient and effective appeals with the relevant claims administrator (Aetna, UHC, BCBS, etc.) and ERISA plan sponsors
  • AVYM can assist NJDPA members on a discounted basis with the following:
    • Learning basic claims appeal procedures 
    • Interpreting EOBs/ERA 835s and recognizing denial types 
    • Challenging and potentially overturning overpayment refund demands and offsets 
    • Challenging and potentially overturning fake “PPO” or “Negotiated Discount” denials
    • Preparing for and responding to audits and SIU reviews.
Watch the video: Understanding the EOP & ERA 835 and recognizing fake PPO discounts. Must be a member to watch the video. 
Watch the video: "Overpayment Recovery (WO)" takebacks and cross-plan offsets. Must be a member to watch the video.

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