The 6th Annual Optimizing Appeals & Grievances Summit

Jun 29, 2021 ‐ Jun 30, 2021



Sessions

Pre-Conference Workshop: The Do’s and Don’ts to Build a Rapport with External Auditors

Jun 29, 2021 9:00am ‐ Jun 29, 2021 10:45am

Identification: TUES01

Join us for an interactive workshop designed to replicate a mock audit. Engage with experienced industry experts to learn the Do’s and Don’ts when preparing for an external audit.

The Do’s and Don’ts to Build a Rapport with External Auditors
•    Learn tips and strategies to not overcommunicate but answer the question at hand
•    Select the right person to manage the audit
•    Discuss proven strategies to practice and prepare in advance of an audit

Speaker(s):
  • David Reid, Senior Director, Operational Performance & Regulatory Support, Florida Blue
  • Delores Stewart, Senior Manager, Senior Manager, Medicare Operations Optimization, Florida Blue
  • Sherry Goble, RN, Clinical Accreditation & Regulatory Consultant, Florida Blue
  • Sarah Simmerson, Consultant, Business Support, Florida Blue

Chairperson Welcome Remarks & Deep Dive: ODAG and CDAG Protocols & Trends for 2021 and Beyond

Jun 29, 2021 11:00am ‐ Jun 29, 2021 11:55am

Identification: TUES001


Chairperson Welcome RemarksChairperson Welcome Remarks

Preview Available

Chairperson Welcome Remarks

Jun 29, 2021 11:00am ‐ Jun 29, 2021 11:10am

Identification: TUES02

Speaker(s):
  • David Reid, Senior Director, Operational Performance & Regulatory Support, Florida Blue

Deep Dive: ODAG and CDAG Protocols & Trends for 2021 and Beyond

Jun 29, 2021 11:10am ‐ Jun 29, 2021 11:55am

Identification: TUES03

•    Explore the latest regulatory and sub-regulatory CMS guidance around appeals and grievances to receive clarity and prepare for the new audit cycle
•    Dissect the changes in Part C and Part D reporting and learn how to effectively adapt your universes and data collection
•    Discuss emerging trends in A&G and discuss the potential impact related to the new administration

Speaker(s):

Panel Discussion: The Impact of COVID-19 on Appeals & Grievances

Jun 29, 2021 12:10pm ‐ Jun 29, 2021 12:55pm

Identification: TUES04

•    Discuss restrictions related to the pandemic that have impacted operations and coverage decisions and how to manage appeals and grievances with copay waiver flexibilities
•    Explore the complexity of telehealth appeals and how payers will manage the influx of these appeals and denials
•    Manage internal processes to effectively address and communicate changes to members

Speaker(s):

Lunch & Virtual Networking Lobby

Jun 29, 2021 12:55pm ‐ Jun 29, 2021 1:30pm

Identification: TUES05

Turn on your camera and join us in the Virtual Lobby for that face-to-face networking experience we’ve all been missing. Connecting with your peers and vendors has never been easier - click on an open seat, say hello to familiar faces, and take part in discussions on industry hot topics. We’ll see you in the lobby!


Panel Discussion: Pro Tips & Strategies for Remote Audit Preparation

Jun 29, 2021 1:30pm ‐ Jun 29, 2021 2:15pm

Identification: TUES06

•    Hear from recently audited health plans on best practices and lessons learned for remote audit preparation and which tools have been most effective
•    Understand the data validation auditor perspective to ensure you are appropriately prepared for CMS
•    Evaluate various approaches for mock audits to determine the best approach for successful audit preparation

Speaker(s):
  • Melissa Rusk, CLSSBB, CPC, Director Claims and BPO Operations, SummaCare
  • Christie Fluery, Director Quality Improvement, Accreditation & Regulatory Programs, Tufts Health Plan
  • Megan Allison, Director, Audit and Oversight, Aetna, a CVS Health Company

Panel Discussion: Drive Star Ratings and Metrics through Excellent Customer Service and Complaint Prevention

Jun 29, 2021 2:30pm ‐ Jun 29, 2021 3:15pm

Identification: TUES07

• Discuss proven direct partnership strategies between customer service and complaint teams to improve member satisfaction and exceed expectations
•    Learn innovative approaches to complaint prevention to drive STAR Ratings and promote excellence in your organization
•    Assess CTM and Customer Service strategies to provide World Class Service

Speaker(s):
  • Pamela Cleveland, LSW, JD, CHC, Chief Compliance Officer, Sidecar Health
  • Nicole Henderson, MBA, Manager, Operations Quality & Compliance - Regulatory Complaints, Blue Cross and Blue Shield of North Carolina
  • Teneshia Harris, Manager of Service Operations, Blue Cross and Blue Shield of North Carolina
  • Hannah LeMere, Director, Special Projects, Cody Consulting

Business Continuity Plans During the Pandemic & Chairperson Closing Remarks

Jun 29, 2021 3:30pm ‐ Jun 29, 2021 4:25pm

Identification: TUES002

•    Hear lessons learned and best practices for business continuity from health plans as they dealt with the disruption of COVID-19.
•    Gain tips to engage and excel in a virtual work environment
•    Build a bulletproof disaster recovery plan


Business Continuity Plans During the Pandemic

Jun 29, 2021 3:30pm ‐ Jun 29, 2021 4:15pm

Identification: TUES08

•    Hear lessons learned and best practices for business continuity from health plans as they dealt with the disruption of COVID-19.
•    Gain tips to engage and excel in a virtual work environment
•    Build a bulletproof disaster recovery plan

Speaker(s):
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