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Session 10 | The Ins and Outs of Managed Care & Medicaid Managed Care

Session Summary

This session will inform attendees of the various nuances of navigating the managed care environment. This including various Medicaid plans and differences in Medicare Advantage coverages. The presenters will discuss authorization and eligibility requirements, plan coverage, and trends for skilled nursing facilities. In addition, this session will review the Notice of Medicare Non-Coverage (NoMNC) advance requirements, Quality Improvement Organization (QIO) for expedited appeals, and a brief overview of levels versus the Patient-Driven Payment Model (PDPM) for Medicare Advantage. Attendees will learn about denial management and appeals to achieve reduced AR along with a brief review of contracting credentialing and prebilling check for first pass clean claims.