When time is of the essence, delayed or denied claims can have negative effects for both providers and patients. For providers, this may mean additional administrative effort, reduced cash flow for your practice, and lower patient satisfaction. For patients, the potential impacts can range from costly out-of-pocket payments for services that might otherwise be covered, financial hardship or emotional distress, and delays in needed medical care, or forgoing follow-up care altogether.

Health care providers are often the first to identify a need for expedited care. Your firsthand knowledge of your patient’s medical history, current health condition, and urgency of their treatment needs is an advantage in advocating for rapid review and prior authorization of care. Timely interventions can prevent medical complications or worsening of your patient’s health status.

What You Can Do to Expedite Appeals
Claims denials can be frustrating for all involved. Here are a few tips for expediting appeals:

• Complete submissions: Make sure all essential clinical information and evidence-based rationale for expedited care is included.
• Help us make a clinical justification: Detailed documentation of a patient’s condition, treatment history, and the expected outcomes of a timely intervention can strengthen the case for expedited care.
• Use “urgent” label selectively: When labelling expedited appeals as “urgent,” take care in triaging only those appeals that are truly urgent with this designation. Labelling all appeals as “urgent” creates a challenge for our team to appropriately prioritize those that need immediate attention, which can result in processing delays.

Benefits for your patients

By intervening on behalf of your patient during the appeals process, you can help ensure that your patient’s voice is heard.. Additionally, this provider‒health plan collaboration creates the groundwork for more efficient and seamless support of your practice in future appeals, where clinical insights inform operational decisions.

Thank you for advocating on your patients’ behalf.

We appreciate your patient advocacy and helping to make it easier for our staff to assess the urgency of an expedited appeal, accelerate decision-making, and reduce patient anxiety associated with waiting for essential care.

Additional information

To learn more about expedited appeals, read this article.