Insurance and Group Health Plan Denials

HHealthcare payers review every claim submitted by providers or individuals for any available reason to deny or reduce payment.  Payer denials are governed by a complex array of laws, regulations, manuals, and private contractual language.  TGF expertly determines which sets of rules govern and develop a comprehensive strategy to reverse the denial and prevent the problem from recurring.  TGF is suited to handle any billing denial, but the types of denials set out below are especially prevalent and TGF has extensive experience dealing with these types of denials.

  • Retro-Termination of Coverage
  • Usual, Customary and Reasonable (UCR) denials
  • Silent PPO’s
  • PPO Network Issues
  • Cobra Issues
  • Emergency Medical Services
  • Coordination of Benefits
  • Medicare as Secondary Payer
  • Utilization Review Programs