Escalation
Our PA assists with our DRG downgrade denials and assists UR with medical necessity denials. For DRG downgrade denials we follow the payor's process for first, second and third (when available) levels of appeal. I have escalated Medicaid denials to the state level on a rare occasion but have not found an option for escalating MCR advantage denials. Is anyone aware of any options beyond the payor's process to further escalate these denials similar to the ALJ being available from medical necessity denials?
Thank you for any feedback,
Lisa McLuckie