97110 and 97140 Out-of-Network Reimbursement: What Payers Should Pay
There is no single mandated out-of-network rate for 97110 or 97140. On a four-unit visit billed around $540, repricers often push payment […]
Usual and Customary Rates (UCR) Explained for Out-of-Network Providers
If your out-of-network checks are coming in short, UCR is probably the number behind the damage. It's the payer's allowed-amount benchmark, and […]
Aetna Out-of-Network Underpayment Appeal Guide for Healthcare Providers
Aetna's initial payment isn't always the final payment. For an out-of-network claim, the practice can often improve its position by identifying the […]
Occupational Therapy Out-of-network Underpayment Recovery Guide for Practice Owners
An occupational therapy practice recovers out-of-network underpayments by comparing each remittance line with the patient's actual benefit methodology, correcting OT-specific coding issues, […]
Out-of-network Appeal Package Checklist and Template for Providers
A winning out-of-network appeal package contains seven components: a marked-up EOB, Fair Health benchmark data, aggregated payment proofs from other payers, medical […]
How to File a NJ DOBI Complaint for Underpaid Out-of-Network Claims
Quick answer: 3-step process: (1) exhaust the payer internal appeal, (2) file at NJ DOBI online complaint portal with a documented Fair […]
Expert Guide: How to Appeal a Denied Insurance Claim
To appeal a denied insurance claim, your practice needs a disciplined process: identify the exact denial reason from the ERA or EOB, […]