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Overturn pre-authorization and pre-certification denials



A little known fact is that when a payor refuses to issue a pre-certification or pre-authorization the provider has the right to appeal that decision. A properly performed appeal can overturn that decision thereby increasing the probability of getting the claim paid before the procedure is even performed.

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  • Out Of Network Healthcare Reimbursement Compliance Program

    For many hospitals and providers, “out of network” may mean “out of luck” as they face an increasing number of payers issuing total claims denials and overpayment recoupments worth millions of dollars. AVYM has developed the 2013 Out-Of-Network Healthcare Reimbursement Compliance Program (OHR), focusing on compliance. The new protocol consists of two onsite programs and is based on the most recent federal and state judicial decisions and regulatory guidance.

  • HEAT Provider Compliance Training

    OIG Provider Compliance Training at oig.hhs.gov