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

Jun 29, 2021 8:00am ‐ Jun 29, 2021 9:45am

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

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

Jun 29, 2021 10:00am ‐ Jun 29, 2021 10:55am

Identification: TUES001


The Impact of COVID-19 on Appeals & Grievances

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

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


Panel Discussion: Pro Tips & Strategies for Remote Audit Preparation

Jun 29, 2021 12:30pm ‐ Jun 29, 2021 1:15pm

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


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

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

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


Panel Discussion: Approaching Regulatory Audits with Confidence

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

Identification: TUES11


Business Continuity Plans During the Pandemic & Chairperson Closing Remarks

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

Identification: TUES002


Pre-Conference Workshop: Master Grievance Classification

Jun 30, 2021 8:00am ‐ Jun 30, 2021 9:45am

Identification: WED01

Join us for an interactive workshop by evaluating customer scenarios with industry experts to advance your grievance classification accuracy.

Master Grievance Classification
•    Evaluate real-life customer grievance examples for both Part C & D to critique documentation and practice classifying properly
•    Learn best practices and common pitfalls when classifying a grievance to avoid inaccuracies
•    Understand CMS measurement standards and explore training tips for safeguarding classification outsourcing

Chairperson Welcome and Takeaways from Day One & The Role of the Provider and Appeals & Grievances

Jun 30, 2021 10:00am ‐ Jun 30, 2021 10:55am

Identification: WED001


The Role of the Provider and Appeals & Grievances

Jun 30, 2021 10:10am ‐ Jun 30, 2021 10:55am

Identification: WED03

•    Understand the impact of the provider on appeals and grievances and use education to foster positive relationships between health plans and providers
•    Learn how provider incentives impact relationships with members and determine your approach
•    Ensure top-notch customer service for appeals and grievances using effective partnership strategies