Closure of all complaints/appeals must be reached within the timeframe specified by the health plan. It is the policy of Facey Medical Group and Facey Medical Foundation to address and resolve all patient concerns in a timely and efficient manner through the involvement of appropriate physicians and management staff. We place special emphasis on education, guidance and strategic involvement of practicing physicians.
#Aetna medicare timely filing limit 2021 professional
The use of data-driven decision making across the organizationĪs defined, Quality Management embraces features of both Quality Assurance and Quality Improvement and goes one step further to embody our management philosophy.įacey Medical Group and Facey Medical Foundation conduct diligent internal processes and audits that review physician and allied health professional provider credentials, medical records, compliance with privacy laws, administration, quality management programs, continuity of care, diagnostic training, medication management, facility and environmental safety and surgical procedures. The active involvement of leaders and empowerment of employees. An emphasis on efficient operational and care systems and patient safety. An emphasis on continuously improving performance in all areas. A focus on patient centered care and patient-provider relationships. 
Quality Management is driven by five basic principles: Quality Management is an all encompassing philosophy that supports our organization’s management infrastructure, policies & procedures and practices.
Provide a cover letter for the entire submission describing each provider dispute with references to the numbered coversheets. Substantially-similar multiple claims, billing or contractual disputes may be filed in batches as a single dispute – provided that such disputes are submitted in the following format: If the contracted provider dispute involves an enrollee or group of enrollees, the name and identification number(s) of the enrollee or enrollees, a clear explanation of the disputed item, including the date of service and provider’s position on the dispute, and an enrollee’s written authorization for provider to represent said enrollee(s) must be provided. 
If the contracted provider dispute is not about a claim, you must provide a clear explanation of the issue, and the provider’s position on such issue. A clear identification of the disputed item, the date of services, and a clear explanation of the basis upon which the provider believes the payment amount, request for additional information, request for reimbursement for the overpayment of a claim, contest, denial, adjustment, or other action is incorrect. If the contracted provider dispute concerns a claim or a request for reimbursement of an overpayment of a claim, the following must be provided: Each contracted provider dispute must contain, at a minimum, the following information: A contracted provider dispute is a provider’s written notice to Facey Medical Foundation challenging, appealing or requesting reconsideration of a claim (or a bundled group of substantially-similar multiple claims that are individually numbered) that has been denied, adjusted or contested, or seeking resolution of a billing determination of other contract dispute (or bundled group of substantially-similar multiple billing or other contractual disputes that are individually numbered), or disputing a request for reimbursement of an overpayment of a claim.
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