Past Agenda

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

• 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, Chief Compliance Officer, Health Plan Operations
SummaCare

Catlin Scheppler MBA, BSN, RN, Manager, Business Operations Recovery Audit and Appeals Department
Ascension Wisconsin

Dana Renicker, Senior Medicare Education Specialist
SummaCare

Chairperson Welcome Remarks

Ana Handshuh, Principal
CAT5 Strategies

CMS Regulatory Update

• Gain familiarity with current CMS priorities and initiatives
• Understand key policy changes for Calendar Year 2022, including those related to Telehealth
• Identify key elements of the CMS COVID-19 Pandemic Response, current vaccine recommendations and regulations

Ashby Wolfe, MD, MPP, MPH, Regional Chief Medical Officer CMS San Francisco, Denver and Seattle Offices
Centers for Medicare & Medicaid Service

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

• 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, Esq., MPH, Principal
NMOC Healthcare Compliance Consulting, LLC 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

Lunch Break

Campfire Session: Rethinking Retention and Reining in the Great Resignation

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

Facilitator :

Ian Wayton, Account Executive
Kiriworks

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

• 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 Leader
Brown & Toland Physicians

Tracy Jones, Senior Compliance Coordinator
SummaCare

Laurie Delgado, VP Appeals & Grievances
Beacon Healthcare Systems

The Competition for New Members: Innovative Supplemental Benefits

• 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

Ana Handshuh, Principal
CAT5 Strategies

Mark Dwinnells, Compliance Manager
Commonwealth Care Alliance

Beth Socoski, Medicare Compliance Director
Longevity Health Plan

Case Study: Transformation of an Appeals and Grievances Department

• Explore the journey from a broken to successful appeals and grievances department
• Evaluate processes, roles, and technology in your AG department
• Discover how processes can be improved by observing and analyzing the workflow

Alicia Gray, Director Appeals and Grievances
Delta Dental

Brittany Lione, Grievance and Appeal Optimization Manager
Delta Dental

Chairperson Closing Remarks

Ana Handshuh, Principal
CAT5 Strategies