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MYTHBUSTER: Does the ALJ system work?
December 6, 2022 8:31 amMYTH: The ALJ System doesn’t work. FACT: The ALJ System DOES work. In a case study, a patient was referred to the... View more
The Case of Phenylketonuria
November 8, 2022 8:30 amIn a recent case study, a patient was diagnosed since birth with Phenylketonuria (PKU) a rare genetic condition, an inherited... View more
Have You Been Haunted By Medical Necessity Denials?
October 25, 2022 8:31 amOne of the biggest pains we face is medical necessity denials. Despite sending proper notifications and requesting authorization on time,... View more
Obtaining Authorization While Patient Is In House
June 29, 2022 8:44 amA large 11 hospital provider member recently submitted a complaint to ERN/TRAF against a health plan who failed to approve... View more
MYTHBUSTER: Are MA plans required to respond to inpatient authorization requests?
June 27, 2022 1:20 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 more