Pillar
Coverage & Appeals
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Medicaid Managed Care Denials: How to Appeal
Medicaid plan denied care? See how to appeal to your plan, decision times and how to ask for a state fair hearing…
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Original Medicare Denials: How to Appeal
Original Medicare denied a claim? See the 5 appeal levels, 120- and 180-day deadlines, and WISeR and Jimmo rules in Kentucky and…
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Medicare Advantage Denials: The 5 Levels of Appeal
Medicare Advantage plan said no? See the 5 appeal levels, 65-day deadline, decision times and 2026 prior auth rules in Kentucky and…
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Self-Funded Employer Plans (ERISA): How Appeals Work
Is your job-based plan self-funded? See the federal appeal rules, deadlines and external review for workers in Kentucky and Indiana, plus a…
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Denied for Reaching a Visit Limit? How to Ask for More
Denied for hitting a visit limit or benefit cap? Learn what codes 119, 151, 96 and 204 mean, how to ask for…
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Claim Denied for a Billing or Coding Error? How to Fix It
Claim denied for a billing or coding error? Decode CARC and RARC codes, learn when a corrected claim beats an appeal, plus…
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Denied as “Experimental or Investigational”? How to Appeal
Denied as experimental or investigational? Learn what codes 55 and 56 mean, evidence that helps, Kentucky and Indiana external review and a…
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Denied Because a Provider Was Out of Network? What to Do
Denied for an out-of-network provider? See your No Surprises Act rights, network exceptions, Kentucky and Indiana appeal steps and a sample appeal…
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Kentucky Workers’ Comp Medical Denials: How to Appeal
Workers’ comp denied care for a work injury in Kentucky? Learn the utilization review, Form 112, ALJ and Board appeal deadlines, plus…
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Indiana Workers’ Comp Medical Denials: How to Appeal
Workers’ comp won’t pay for care after a work injury in Indiana? Learn the Board’s informal help, the 2-year claim, Full Board…
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