ERN/NCRA/TRAF offers a Denial Prevention Program and Unit to protect your health care delivery system.
As a trusted name in reimbursement advocacy, we strengthen your voice to redress unfair payment practices with state and federal regulatory agencies.
The Denial Prevention Unit works in concert with your Case Managers to:
- Fight prospective care (pre-certification) denials.
- Fight concurrent or continuity of care denials and initiate a notice of disagreement of care to trigger the plan’s responsibility to assume care for the patient under Health and Safety Code 1371.4(d.)
- Expedite transfer of a patient to ensure continuity of care.
- Convert tracking and reference numbers to authorization numbers to avoid denied days (beyond stabilization) for statutorily deemed authorized services.
- Challenge a plan’s refusal to conduct a retrospective review for unauthorized medically necessary services (provided after normal business hours, or when the patient’s insurance information was not provided, etc.)
- Challenge improper requests for medical records to review services prior to the issuance of an authorization.
- Challenge improper denials of care after patient is discharged under Title 28.
- Challenge a reduction of level of care or disputed healthcare service under Health and Safety Code 1374.30(b.)
We thrive to exist as an extension of your Case Management and Business Office. We passionately understand the importance of assisting you advocate for medically appropriate healthcare for patients while being properly reimbursed for the services you provide.
IF WE DON’T GET THE AUTHORIZATION NUMBER FOR YOU TO BILL WITH OR REVERSE THE PAYOR’S ACTION OR INACTION, YOU DON’T PAY A DIME.
*With contingency and retainer programs available, our primary goal is to ensure the faithful enforcement of all public health and safety laws that relate to timely reimbursement and prevent improper prospective, concurrent and retrospective denials. Our presence will help you instill preventive measures to encourage third party payors to adjust their practices and come into compliance with state and federal laws.
CLAIMS REPRESENTATION HOTLINE NUMBER: (714) 995-6900 ext. 6935
*TRAF Early-Out members receive this service complimentary, without additional charge.