Team Peak Performers: UM Denials and Appeals

The Denial and Appeal (D&A) Team recently had a major change that impacted our day-to-day operations. The State, Health and Humans Services Commission (HHSC) implemented new rules which began on May 1, 2022. Little did the Denial and Appeal Team know their day-to-day operations would be impacted. The new HHSC implementation affected the D&A team workflow and processes. The changes in the letters were such a big impact in a way that a task that usually takes 10 minutes, is now taking us 30 minutes or longer to be completed. Not only did the new rules affect our day-to-day operations, but it also affected our timeline on how we process our letters. Jennifer Bierie, D&A coordinator asked the right questions that helped our team navigate the new letter processing. She stepped up to help leadership work in a collaborative effort to ensure our members and providers were able to read the letters effectively and compressively. She worked countless hours to ensure the letters were sent in a timely manner. Josefina Jungo, Olga Palacio, Evelyn Turcios and Jennifer Asamoah spent hours proofreading and correcting the new letters for errors before these letters reached members and providers.

The team also worked in collaboration with leadership to ensure proper corrections and adjustments were made in Tapestry. They were able to identify problems and identify areas where corrections needed to be made. With the help of these ladies, going above and beyond, they exemplify what a team effort means and deserve to be nominated for Peak Performer.