CASE STUDIES
Obtaining Authorization While Patient Is In House
MYTH: MA Plans are not required to respond to an inpatient authorization request. FACT: MA Plans ARE required to respond to an inpatient authorization request. A large 11 hospital provider member recently submitted a…
Published on June 29, 2022
CASE STUDIES
Community Rallies Around Yorba Linda Teen in Need of Operation
ERN in the news! This morning, I saw this piece aired by Channel 5 of a young boy we successfully represented against the State of California (several years) ago and…
Published on April 6, 2019
CASE STUDIES
How to Challenge Improper Denials of Emergency and Post-Stabilization Services
INTRODUCTION As a provider in the acute medical setting, you have undoubtedly experienced the difficulty in obtaining prompt reimbursement for emergency and post-stabilization services rendered. Imagine a situation in which…
Published on December 4, 2018
NEWS
Can an HMO make a medical decision without looking at medical records?
Sometimes you are the only thing that stands between the single crushing blow of HMO and a patient or provider. – Ed Norwood On the surface, requests for medical records…
Published on February 27, 2018
CASE STUDIES
24 Hour UM Access
Hello, you have reached the UM Department. We are open Monday through Friday, 8 a.m. to 5 p.m. Please leave your name and number and we will return your call.…
Published on December 8, 2017
CASE STUDIES
Monarch Healthcare
ERN/TRAF wins treatment for a 16 year old student-athlete in one (1) week. View and download TRAF’s patient case study to see how this denial was overturned.
Published on May 16, 2017