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ERISA Seminar in Ohio
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The Most Powerful & only Seminar in the
U.S.
on Health Care
ERISA Claim
Denials & Appeals |
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New Seminar in Ohio
New federal law/ERISA
Preservice Claims
Pre-certification Denials and
Appeals |
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When |
December 4, 2003, 9:00 a.m. until 4:00
p.m., Thursday |
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Where |
Ohio Prestwick Country Club in Akron, Ohio
(2220 Raber Rd, Phone: (330) 492-4180) |
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For |
Health-care
Providers, Surgical Centers and Hospitals, Medical Billers & Coders,
Office Managers, TPAs, ERISA Plans, UR Agent, Reimbursement
Managers, Patient Accounts Receivable, CEO's, CFOs, State Insurance
Regulators.... |
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What |
New federal
law/ERISA Preservice Claims, 80% Health Claims, Pre-Certification,
Prior Authorization by Managed-care Plans, Request, Denials and
Appeals,
ERISA Promt Pay.
Anyone handles
managed-care precertification/prior authorization procedures,
denials and appeals must comply with new federal law, ERISA, after
January 01, 2003. |
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How Much |
Nonmember $175/Each, Member $75
(Staff, $25) |
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Payment
Contact
Sponsor |
ERISA/C-PAC seminar
Sprandel Chiropractic Clinic
1412 Cleveland Ave
Canton, Ohio 44703
Phone# (330)-455-4602
Fax: (330)-455-2468
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Question |
Tel: 330-455-4602;
630-736-2974 (for ERISA Q only) |
Past seminars in
Ohio
OHIO State
Chiropractic Association
Toll Free: (800) 837-6721
Tel: (614) 221-9933
Fax: (614) 221-2335
For Information Contact: |
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Judson Sprandel, DC.
1412 Cleveland Ave NW
Canton OH 44703
Tel:
330-455-4602
Bluecrus@AOL.com |
Timothy Weir, DC.
3325 Middlebranch Rd NE
Canton OH 44705
Tel:
330-452-4040
WeirDC@neo.rr.com |
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Spring
2003 Hall of Fame Convention
April 12 & 13
KSU Convention Center
Canton Ohio
12 hour license renewal
(pdf)
Hotel info (pdf) |
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Registration Form & Fees (pdf)
$295.00 per DC
$200.00 for DC licensed 2 years or less
$95.00 for CA x-ray CE
$20.00 for CA Sunday only
(includes continental breakfast and lunch on
Saturday and continental breakfast on Sunday)
$40.00 per person for the Professional Football Hall
of Fame including dinner (Optional Activity)
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Seminar
(details)
Health-care Claim Denial &
Appeals
under
New Federal Claim Regulation
Saturday &
Sunday,
April 12-13, 2003 |
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What's
???
??? ???
New?
New Federal Claim
Regulation (Final Rule)
Benefit
Claims Procedure Regulation (FAQ)
Amendments to Summary Plan Description Regulations
(Final Rule)
Patient's Rights Claims Procedure Regulation
(Fact Sheet)
Effective January 01, 2003
You
Must Be in Compliance |
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Ohio Dept of Insurance - Important Complaint Information
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1. Microsoft
Word - INS9026.doc
2.
Microsoft
Word - INS9016.doc
3.
Ohio
Dept of Insurance - HMO Information
4.
Ohio
Dept of Insurance - Office of Life and Health / Managed Care
5.
Microsoft
Word - INS9025.doc
6.
Bulletin
83-5 Uniform guidelines for submission of schedules of charges by health
maintenance organizations
7.
Rule
Making.PDF
8.
Ohio
Dept of Insurance - Office of Financial Regulation Services
9.
Where
Fraud Occurs 10.
Analysis of Data from Independent Review Organizations
Ohio's External Review Experience (HealthLeaders)
Excerpt: "In the wake of the U.S. Supreme Court's ruling that
patients may not sue their HMOs in state courts for coverage
decisions, independent external-review programs across the country
will become even more critical. External review is designed to resolve
medical necessity disputes before they reach courts."
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TITLE [39] XXXIX
INSURANCE |
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Associations for Physicians, Hospitals, Health-care Providers
We are willing to work
with any associations with your co-sponsorship and significant discount
for tuitions and reference books. You may
e-mail or
telephone for more details.
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$10,600 ERISA Claim
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| Recent Federal Court Ruling in a Case with
$10,600 medical claim, insurance Co. refused to pay, provider
made numerous demand for payment in almost one year, but no
appeals filed, the court dismissed the lawsuit because provider
failed to exhaust administrative remedy, as required under ERISA,
by filing ERISAclaim appeals. This situation is so popular
in health-care community. |
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$37,350 ERISA Claim
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| Health-care provider alleged medical claims
submitted to Aetna for reimbursement, Aetna asserted no receipt
of medical claims, no written denials. Health-care
provider failed to present proof of claim submission, claim
denial and ERISA claim appeals. This case was dismissed. ERISA
health-care claims are handled in federal court, state law is
generally not applicable.
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Codified in Title 29 of the
Code of Federal Regulations:
Regulations
Selected
links:
2520.102-3 Contents of summary plan description.
2560.503-1
Claims procedure. |
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