Insurance Gap Exception Assistance - Oral Surgeon
Fixed price
I need someone to prove my network is insufficient in MN and qualifies for a gap exception. Required: Obtain proof of network inadequacy to support gap exception for orthognathic surgery. The network is unreasonably small in the MN metro area. - Audit BCBS’s Aware in-network oral surgeons in Minnesota against state/federal standards (e.g., 60-mile/60-minute rule for specialty care), trying to show network inadequacy. - Evaluate BCBS Aware network provider directories for accuracy (e.g., outdated “accepting new patients” status, wait times greater than 30 days), trying to show network inadequacy due to lack of timely availability. - Obtain proof of unreasonable appointment delays for new patients in excess of 30 days. - Analyze provider capacity and obtain proof to support network gap exception - Analyze knowledge gaps (e.g., procedure-specific expertise gaps) and obtain proof to support network gap exception - Apply Minnesota Statutes §62K.10 (network adequacy) and any other applicable BCBS policies and laws. - Draft a formal argument with supporting documents and evidence citing network inadequacy for submission to BCBS - Highlight burdens of out-of-state care in Hudson, WI, instead of MN (e.g., travel costs, care continuity issues, etc). - Contact provider offices of in-network locations to obtain necessary evidence for a gap-exception Required Knowledge: Understanding of gap exception processes and appeals. Understanding laws related to gap exception Ability to navigate BCBS website to assess Aware Network Ability to work to obtain BCBS gap exception forms Experience seeking and obtaining gap exceptions Ability to contact provider offices of in-network locations to obtain necessary evidence for a gap-exception Persuasive writer Strong organization skills
Keyword: Data Entry
Price: $100.0
Communications Preauthorization Phone Communication Insurance Policy Analysis Insurance Insurance Agency Operations Persuasive Writing