HANYS Hosts SAE's Presentation on Managing Utilization Review in Light of Parity

Early this month, SAE headed to Tarrytown, New York to present at the Behavioral Health and Primary Care Strategies, Weapons, and Tactics (SWAT) conference, hosted by Healthcare Association of New York State (HANYS). This year's SWAT program, Strategies for Success, was designed to provide guidance on the competencies and skills needed to tackle redesigning the primary care system, understand the risks and rewards of value-based payment, integrate services, and address payer denials.

The Mental Health Parity and Addiction Equity Act (MHPAEA) and its regulations were passed and implemented to end discriminatory health insurance practices against those with mental health and/or substance use disorder issues. Unfortunately, obstacles to treatment continue to persist within the health insurance industry. During SAE's presentation at the HANYS conference, the Parity Compliance team focused on helping attendees:

  • understand the basic medical necessity elements for the level of care being requested to make sure the patient meets those requirements;
  • know what to look for in a denial letter and determine if the criteria applied are appropriate;
  • know the essential ingredients for a properly constructed appeal;
  • understand what date must be maintained in order to monitor and manage denials and appeals; and
  • learn how to organize and analyze the data on a payer-specific basis to target improvement opportunities that yield more revenue or lower internal administrative costs.