Appeals

New regulations, legislative updates and the changing health care industry make eligibility determinations an ever-evolving process. Ensuring members are enrolled in the correct plan, assessing requests for reconsideration and pursuing appeals for denied benefits when appropriate, are critical parts of the process.

Public Sector Partners works with clients and members to manage the appeals process from start to finish. Clients benefit from our extensive knowledge of public health and pharmacy programs and our expertise in working with government agencies.

Our appeals services include:

• Gathering member information
• Analysis of facts and applicable regulations and policies
• Rendering of appeal decisions
• Representation at formal hearings
• Ongoing reporting and analysis

For more information on our Appeals services, please contact PSP at tpaservices@publicsectorpartners.com.