The 7th Annual Optimizing Appeals & Grievances Summit

Jun 6, 2022 ‐ Jun 7, 2022

Standard: $500.00


Appeals and Grievances 101: Learn the tools to help you thrive- not just survive

Jun 7, 2022 8:00am ‐ Jun 7, 2022 9:45am

Identification: TUES01

•    Understand the rules and the critical importance of timeliness and preparedness
•    Learn about how appeals and grievances impact a health plan’s performance
•    Discover how to improve member satisfaction and avoid harmful mistakes.

  • Deborah Marine, JD, CHC, Former Compliance Officer, Summa Care
  • Catlin Scheppler, Manager, Business Operations Recovery Audit and Appeals Department, Ascension Wisconsin
  • Dana Renickerd, CHC, Senior Medicare Education Specialist, SummaCare

Chairperson Welcome Remarks & Keynote Presentation: CMS Regulatory Update

Jun 7, 2022 10:00am ‐ Jun 7, 2022 10:55am

Identification: TUES001

Appeals and Grievances in the Post-Pandemic Era: Acknowledging the Uncertainty is the New Normal

Jun 7, 2022 11:10am ‐ Jun 7, 2022 11:55am

Identification: TUES04

•    Learn how the new public health emergency rules and flexibilities are impacting appeals and grievances
•    Discuss emerging trends concerning Covid testing and vaccine booster coverage
•    Discover best practices for member-facing representatives to deal with member complaints and behavioral issues

  • Osato F. Chitou, Principal Consultant, NMOC Healthcare Compliance Consulting d/b/a Compli by Osato
  • JoAnn McDaniel-Chinn, Medicaid Compliance Officer, Simply Healthcare Plans
  • Joe DiBiase, Director, Medicare Operations- Call Center and UM, Magellan Health

Campfire Session: Rethinking Retention and Reining in the Great Resignation

Jun 7, 2022 12:30pm ‐ Jun 7, 2022 1:15pm

Identification: TUES05

Turn on your camera and join us in the Virtual Campfire Session: Bring your comments, insights, and questions to an intimate conversation and be part of a group discussion and peer-to-peer learning•    Understanding the challenges of employee retention and turnover in appeals and grievances
•    Hear peer best practices for tackling volume with your internal workforce
•    Evaluate cost advantages to outsourcing appeals and grievances
•    Learn how to prepare an action plan for efficient workflow when short staffed


Trend and Root Cause Analysis: The Data is in Your Hands

Jun 7, 2022 1:30pm ‐ Jun 7, 2022 2:15pm

Identification: TUES06

•    Analyze your current data to identify top drivers of appeals and grievances and how to make up front changes to your process
•    Identify broken processes or delegated vendors that are driving volume
•    Explore actions to manage unnecessary volume, and proactive remediation
•    Create a plan that includes business partners collaboration

  • Celeste Ivey, Director II, Government Business Division Grievances and Appeals, Anthem
  • Amber Duenas, Appeals and Grievances Specialist, Brown & Toland Physicians
  • Tracy Jones, Senior Compliance Coordinator, SummaCare
  • Laurie Delgado, Vice President, Appeals & Grievances, Beacon Healthcare Systems 

The Competition for New Members: Innovative Supplemental Benefits

Jun 7, 2022 2:30pm ‐ Jun 7, 2022 3:15pm

Identification: TUES07

•    Learn how to provide non-medical services under a medical plan
•    Analyze how supplemental benefits impact appeals and grievances
•    Explore innovative practices when designing strategy, benefit limits, and a communication plan for your members


Case Study: Transformation of an Appeals and Grievances Department & Chairperson Closing Remarks

Jun 7, 2022 3:30pm ‐ Jun 7, 2022 4:30pm

Identification: TUES002

Best Practices for Identifying and Classifying Appeals and Grievances

Jun 8, 2022 8:00am ‐ Jun 8, 2022 9:45am

Identification: WED01

  • Discuss examples of customer complaints and compare results regarding right documentation and proper classification
  • Learn new CMS requirements and common risks when classifying multiple grievances in one call to avoid inaccuracies
  • Discover best practices for addressing quality of care grievances


Chairperson Welcome & Takeaways from Day One & Keynote Presentation: Timeliness vs. Remote Work: Tackling Ethical Issues

Jun 8, 2022 10:00am ‐ Jun 8, 2022 10:55am

Identification: WED001

ODAG and CDAG New Audit Protocols

Jun 8, 2022 11:10am ‐ Jun 8, 2022 11:55am

Identification: WED04

•    Learn the challenges faced by health plans to adapt to the new universe layout
•    Understanding the latest requirements in grievance classification and description / implement strategies to prepare for the next audit cycle
•    Review new dismissal requirements and validate with experts’ interpretation
•    Learn strategies to help you and your vendors increase consistency when collecting data for an audit-proof universe