Let Us Fill the Gap
Appeals are yet another area of focus where we can provide independent expertise to fill very important voids in staffing or outsourcing.
Issues We’ve Observed:
- Misunderstanding of ERISA timeframes
- Use of same claim team to address appeals
- Inaccurate or incomplete denial/decisions letters
- Decisions based on undocumented information
- Denial or decision letters not in accordance with ERISA
- No de novo review
- Not using appeals for training and development
How SALT Can Help:
- Thorough de novo review of adverse claim decisions
- Ensuring appeal process remains independent of claim organization
- Compliance with ERISA timeframes
- Identifying training and development opportunities
- Identifying risk management trends
- Providing feedback to claim organization
- Conducting full and fair review for claimant to exhaust their administrative remedies
- Conducting full and fair review for carrier to ensure appropriate decisions are made
- Educating claimant/customer – ERISA, appeal procedures and next steps if any
