1. Kristen Edsall R.N., B.S.N., M.S.N. Manager, Payer Relations
Ensuring Appropriate Reimbursement: Commercial Insurance Tips and Tools
Kristen Edsall R.N., B.S.N., M.S.N.
Manager, Payer Relations
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4. Instructions on How to Answer Poll
9/18/2019
Instructions on How to Answer Poll
Please use the question pop-up box on the right side of your screen
Make your selection by clicking the radio button next to the answer that best fits your situation
Click the “Submit” button
Once the poll is closed it will take 20 seconds for results to display
We have 3 poll questions at various spots in today’s presentation – here is how the polling works.

5. Reimbursement Support Center Project Goals
9/18/2019
Reimbursement Support Center Project Goals
Create new tools to help transplant center staff work with payers in order to:
Decrease reimbursement barriers by providing quick and easy-to-use information and tools
Communicate effectively and work directly with payers on reimbursement issues and access challenges
Here at NMDP we get a lot of questions from transplant centers that relate to insurance and reimbursement. Our goal with the expansion of our web resources is to help provide key information and resources so that every transplant center has access to this information and has one place to find the information. The content on the site is designed to help decrease barriers to getting timely and accurate reimbursement. We also want to foster and encourage your centers to develop great relationships with your payers as this will go a long way when things don’t go right.

6. New Reimbursement Support Center
9/18/2019
Network.BeTheMatchClinical.org
Transplant Centers/Access to Transplant OR
Network.BeTheMatchClinical.org/reimbursement
The reimbursement resource center can be found on the network site and it is not password protected, anyone can access this area.

7. New Features Payer-specific content Checklists Letter templates
9/18/2019
Payer-specific content
Checklists
Letter templates
Appeals process charts
Payer organizational structure chart
Links to learn more
Important tips
Glossary of definitions
Here is a brief summary of the new tools on the site.

8. Resource Center Homepage Features
Access to recorded webinars such as this one
Support advocacy efforts!
Find answers to questions we have received from transplant centers
Find out how to contact us here

9. Commercial Insurance: Deep Dive
Learn about Commercial Insurance A to Z & access tools to increase efficiency
Understand different types of insurance products
Learn how the Medical Policy process works and how you can get involved
Access letter templates and other tools

10. Decode the language and acronyms of the payer/insurance world

11. Learn about payers clinical departments and what they do

12. Understand how payers are organized so you know how to navigate when you need to

13. How well do you understand how different insurance types (fully insured vs employer based) impact HCT coverage:
I am knowledgeable and comfortable with the differences
I know there are differences in coverage, but could benefit from more information
I don’t really understand the difference

14. Commercial Insurance Overview
9/18/2019
Commercial Insurance Overview
Page Tool

15. Commercial Products
Better understand how insurance plan type impacts coverage and requirements

17. Commercial Policies

18. Commercial Medical Policy Process
Get involved with your payer’s medical policy committee

19. Commercial Coverage
9/18/2019
Make sure you are very familiar with your payers policies and how they relate to coverage for your patients!

20. Commercial Authorizations

21. Commercial Authorizations
9/18/2019
 If you received authorization for care from one payer and the patient changes payers you must get a new prior authorization from the new payer
Request the urgency that fits with the patient situation

22. How familiar is your center with changes to the appeals process as a result of reform?
Very familiar – we have updated our processes
We know about the changes but not in detail
Changes? What changes?

23. Due to reform appeals processes are more standardized!
Page Tools:
Step-by-step guide for standard appeals
Step-by-step guide for urgent appeals
Appeal Letter templates

24. Post ACA appeals have standardized process

25. Appeal letter templates
Standard Appeal
Level 1 appeal letter
Standard Urgent
Level 2 appeal letter
Appeal letter templates
For each type and stage of appeal

26. Many coding tools and content available
HCT Coding
Many coding tools and content available
Page Tools

27. General Coding Tools Code Crosswalks

28. Clinical Trial Coverage
Patients must be enrolled in an *approved* clinical trial in order to get coverage
Page Tools

29. FAQ’s
Don’t forget to check here for specific coding direction

30. Webinar Announcements & Recordings
Check back to see what is coming up and catch up on what you missed!

31. Can I Download and Print Tools?
Materials Catalog
Access and download all available materials and tools via the Materials Catalog
Filter on Reimbursement under Clinical Topics

32. Your Feedback is Valued
Can you easily find what you need?
Is the information easy to understand?
Are the tools helpful?
Are there additional tools you would find beneficial?
Are there tools you have that you would be willing to share?

33. 9/18/2019
Register for Our Next Webinar Reimbursement Support Center: Health Policy & Advocacy in the HCT Community: Get Involved! August 18th, 1-2pm CDT
We will be hosting a monthly series to deep dive into sections of the resource center.

34. Stay Connected Subscribe to our e-news Join the BMT Financial Forum
Learn about upcoming webinars
Stay current on new tools
Receive notifications about advocacy efforts and how you can help
Join the BMT Financial Forum
Connect with peers from other transplant centers for knowledge sharing
Communicate with NMDP about advocacy efforts and learn how you can help

35. Evaluation
When the webex ends please look at your browser to see a new window with the evaluation – you can complete the evaluation right now
If you close out of that screen accidentally don’t worry we will send you a link via
Within a week you will get an with a link to the eval

36. NMDP/Be the Match Contact Kristen Edsall Manager, Payer Relations

37. THANK YOU!!