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Enhancing Appeals & Grievances and Improving ODAG & CDAG Readiness

Methods to Improve Operational Effectiveness and Audit Outcomes

March 6-8, 2019
AC Hotel Nashville Downtown | Nashville, TN

As CMS eases up on certain enforcement actions, scrutiny of your appeals and grievances operations and clinical determinations is primed to intensify. With the OIG’s recent report calling for CMS to step up oversight efforts, and major changes to the Managed Care Manual, you need best practices and proven methods to streamline your operations and boost readiness for the always-difficult ODAG & CDAG protocols.

This education activity has been submitted to the Compliance Certification Board (CCB)® and is currently pending their review for continuing education.

Key topics will include

Analyzing and Avoiding the Most Common ODAG & CDAG Findings
Tips and Strategies to Implement New Managed Care Manual Guidance
Best Practices to Correctly Classify Appeals & Grievances

Proven Methods to Enhance Clinical and Compliance Oversight of Delegated Entities
How to Use Appeals Star Measures to Drive Operational Performance and Compliance

Who will you meet?

  • Directors or Managers of Appeals & Grievances
  • Compliance Officers, Directors and Managers
  • Medical Directors and Medical Management
  • Quality or Operational Performance Improvement
  • Regulatory or Compliance Analysts
  • FDR or Vendor Oversight Directors or Managers

Benefits of attending

Enhanced opportunities to network and exchange ideas and strategies with peers and colleagues from other health plans
Learn from audit-tested experts who will share how their plan approaches the unique operational and compliance challenges of appeals & grievances
Ensure you’re ready to succeed on the most difficult program audit protocols
Hear from other plans on how they are addressing issues such as re-openings, IRE overturns, call center staff and customer service training, and more


Anne Marie Youlio

Pharmacy Program Lead, Attac Consulting Group

Chris Curcio

Manager of Medicare Appeals & Grievances, Independence Blue Cross

Destiny Gordon

Manager, Operations, MA Appeals & Grievances, BlueCross BlueShield of Tennessee

Ken Stockman

Chief Executive Officer, Beacon Healthcare Systems

Melissa Whitley

Vice President of Client Services, BluePeak Advisors

Rick Evans

Senior Consultant, Compliance Solutions and Data Audit Group, Attac Consulting Group

Crescent Moore

Senior Consultant, BluePeak Advisors

Darlene Black

Director, Compliance, SCAN Health Plan

Jill Borrelli

Director of Appeals, Grievances & Ops Business Performance, Tufts Health Plan

Laura Taylor

Chief Compliance Officer, Indiana University Health Plans

Nancy Erickson

Director, BluePeak Advisors

Sherry Goble

Clinical Accreditation & Regulatory Consultant, Florida Blue

Ben Chick

Senior Manager of Appeals & Grievances, Florida Blue

Darryl Breakbill

Manager, Grievance and Appeals Operations, Santa Clara Family Health Plan

Julie Donaghey

Director of UM Program Oversight, Member Appeals & Grievances, BMC HealthNet Plan/Well Sense Health Plan

Niejadd Evans

Compliance Officer, MedImpact

Owen McGuire

Director, Operations and Support, Independence Blue Cross

Cassandra Blair

Vice President, Health Services, Scott & White Health Plan

Cheyenne Ross

VP Compliance & Regulatory Affairs, Arizona Complete Health, a Centene subsidiary

Deborah Marine

Compliance Officer, SummaCare

Ken Nunez

Vice President, Compliance Solutions, Attac Consulting Group

Mariah Emerich

Supervisor, Govt Programs Appeals & Grievances, Moda Health

Philip Ramirez

Chief Compliance Officer, Prominence Health Plan



March 2019


Optional Pre-Conference Workshop

  • 12:00 PM
    Pre-Conference Workshop Registration and Networking Luncheon
  • 1:00 PM

    Workshop A: Optimizing Appeals & Grievances for Medicaid and Commercial Lines of Business

  • 1:00 PM

    Workshop B: An In-Depth Analysis of Common Conditions in ODAG & CDAG, Corrective Actions Taken, and Remediation and Validation Outcomes

  • 4:00 PM
    End of Day


March 2019


  • 7:00 AM
    Conference Registration and Networking Breakfast
  • 8:00 AM

    Conference Sessions

    • - Welcome and Opening Remarks
    • Panel Discussion: Interpreting Regulatory Changes and Their Impract to Operations and Compliance
    • - Proven Methods to Enhance Operational and Compliance Monitoring of Clinical Determinations
  • 10:15 AM

    Networking Break

  • 10:30 AM

    Conference Sessions

    • - Panel Discussion: Best Practices to Improve Collaboration and Training for Front-End Customer Service Staff to Avoid Misclassifications
    • - Case Study: Best Practices and Lessons Learned Implementing a New Appeals Platform for Our Medicare and Commercial Lines of Business
  • 12:15 PM

    Networking Luncheon

  • 1:15 PM

    Conference Sessions

    • - Compliance Oversight Strategies to Enhance Call Log Monitoring
    • - Overcoming the Complexities of Building Accurate Universes
  • 3:00 PM

    Networking Break

  • 3:15 PM

    Conference Sessions

    • - Building a Consensus on Re-Openings: An Interactive Discussion
    • - Networking Roundtables
  • 5:00 PM

    Networking Reception

  • 6:00 PM

    End of Day


March 2019


  • 7:00 AM
    Networking Breakfast
  • 7:50 AM

    Conference Sessions

    • - Chairperson’s Recap of Day One
    • - Best Practices and Lessons Learned on MMP-Specific Audit Protocols
  • 9:00 AM

    Networking Break

  • 9:15 AM

    Conference Sessions

    • - Featured Panel: What We Learned Going Through Our Audit
    • - Panel Discussion: Practical Methods to Improve Appelas- and Grievances-Related Star Measures
    • - Streamlining Organizational Processes to Improve Determination Timeliness
  • 12:00 PM

    Networking Luncheon

  • 1:00 PM

    Conference Sessions

    • - Strategies to Improve Outreach, Case Documentation and Notification
  • 2:00 PM

    Summit Conclusion



AC Hotel Nashville Downtown

410 5th Ave
Nashville, TN 37203
(615) 682-0260

Opening in December 2018, the new AC Hotel Nashville Downtown is located across the street from the Music City Center & steps from the Country Music Hall of Fame, Ryman Auditorium, Bridgestone Arena & the famed Lower Broadway featuring classic Nashville honkytonks. The full-service hotel will feature an outdoor pool and bar, a fitness center, complimentary wi-fi, and the 21st-floor conference space overlooks Nashville’s beautiful skyline.
Start the day off right in the AC Kitchen with an innovative, European-inspired breakfast including items such as Sweet & savory Spanish egg tarts, imported, freshly sliced Iberico ham & French croissants. In the evening relax in the AC Lounge where bartenders serve up expert, local knowledge along with craft beer, hand-crafted cocktails, & tapas-style small plates

Hotel MdR

IEN has negotiated a special room rate of $279/night. The venue is only offering this rate until February 12th, 2019, so please book early.  Once the room block sells out pricing and availability will be at the venue’s discretion.  
Call (888) 236-2427 and ask for the AC Hotel Downtown Nashville.  Mention  the Insight Exchange Network ODAG/CDAG Meeting to reserve your room.  Alternatively, you can click this link to reserve online.

IEN has also reserved additional rooms at the Springhill Suites Downtown Nashville that shares a building with the AC Hotel.  The rooms are $279/nt, and the rate is available until February 12th.  Please call 615-514-2502 or use this booking link to reserve online.  When calling, please mention either "Insight Exchange Group" or "ISE ISE A."

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