Archive for August, 2011

Cowtown Netweavers 08.31.2011

August 31, 2011

Today was a special day at Cowtown Netweavers.  It marks a 1-year Anniversary for me serving as  Board Member for the group!  It has been an incredible experience and I have loved every minute of it.  However, as I move forward in trying to really grow my business, I have come to realize that I can no longer serve in this position and must resign.  I must tell you that it was hard to do, but sometimes we have to refocus are ventures elsewhere!


The topic discussed today was Blogs.  A very interesting topic because it is something I enjoy doing…not only for the benefit of education and helping others, but because I enjoy writing.  I am going to recap today’s meeting highlights:

Blog = web & log to become the term blog

Key Elements needed in a blog:

  • title = attention getting
  • body = 300-500 words, key words that need to be written in it 2-4x’s
  • tag = what the blog is about
Reasons to blog:
  • increase ranks on Google
  • make yourself known as an expert
  • increase awareness on a topic
Do you blog?  Do you enjoy blogging?  How often do you blog?  Any comments or suggestions to my fellow networking friends & colleagues?

Do you let others hinder your plan?

August 29, 2011

Today, I will take a path different then the normal blog post and am going to write a personal story on my blog…one that I hope will encourage you to be you and follow the direction of giving out of a pure heart to help others.

I have been attending networking groups for a year now.  Each group is different in format from how long the meetings are, to the structure of the meetings, to the type of attendee’s with B2B, B2C and MLM format.

Earlier this year, I was the spot light at one of these events and had 20 minutes to speak about my business.  A Board Member of the group asked me what I was going to speak on and I informed him that I was going to share with the group how to understand and maximize your insurance benefits along with information regarding their EOBs (Explanation of Benefits).  He informed me that I was going to utterly bore the group and that “their eyes are going to glaze over not too long into your speech”.  I must tell you that this individuals comment, totally annoyed me!  The individual was old enough to be my Grandpa and his lack of encouragement made my respect for him as a leader of the group be diminished.  If I were to have spoken about Medical Billing in a way that I know it, yes, the group would have been utterly bored because this topic is not going to interest very many people.  However, I was taking my 15 years experience in the industry and turning it into an informational session that would provide them with helpful tips and knowledge that they could walk away with.  I knew it would benefit many, if not all the attendee’s.  I spoke and left enough time for questions.  Out of all the times I have attended this group, there are usually 1-3 people with questions. I had about 10 or 12!  At the end of the meeting, that previous individual that had no encouragement for me came up to me and told me “Wow, that was an incredible speech.  I was impressed.  You really had some great information.”  I said “Thank You.  My goal is to be helpful and provide information that everyone can use.”  I could have said a million other things, but the fact was I proved what my company does in a different way made a great impact more than anything I could have ever said.  Because of the way I approached this opportunity and the information I provided, an attendee that was in the audience wanted me to speak to their client base on the same subject.  This event occurred this past Saturday and you can read the agenda here.

You never know what opportunities will come from your efforts.  I want to encourage you in a few small ways:

  • Be willing to share and help others with information that they can take with them and utilize in their life.
  • Don’t give up when someone says things to discourage you and decrease the wind in your sails or go so far as to poke a hole in it.
  • Continue with your plan that you know to be true.  The evidence will be seen directly by those listening and the truth will not be hid.

Have you experienced situations like this?  What did you do to combat the argument?  How did you create peace inside your soul and move forward with your plan?  We would love for you to share a story below!


August 25, 2011

“Motivation is what gets you started. Habit is what keeps you going.”  – Jim Rohn

Speaking Engagement ~ Saturday, August 27th, 2011

August 25, 2011

Event:  Financial Seminar hosted by Armstrong Purselley Wealth Management Group

Speaker:  Misty Gilbert  (1 of 4)

Toptics To Be Discussed:

  • Understanding your Explanation of Benefits (EOB’s):  What they are and how to read them
  • Deciphering between a bill and a notice, information on statute of limitations and your responsibilities
  • Negotiations with a Healthcare Provider and timely filing guidelines
  • Appeal Process: Key elements needed for claim reconsideration
  • How Patient Advocate services benefit you
  • The death of loved ones and their medical bills


Information needed for filing Insurance Claim Complaints

August 22, 2011

Know Your Claim Filing Requirements

  • Know your contractual obligations, including where to file claims, claim filing deadlines and your fee schedule
  • File claims to the correct claims filing address
  • File claims with carriers in a timely manner
  • File claims using a method that will document when the claim was received by the carrier
  • Keep records of your phone conversations and all written correspondence with each carrier regarding the status of a claim
  • Update your accounts receivables as soon as claim payments are received
  • Don´t submit duplicate bills. If there is a genuine need to send a duplicate bill to a carrier, mark it clearly as a duplicate

Keep Documentation for Filing Complaints

Be sure to include the following when filing a complaint with the Texas Department of Insurance (TDI) regarding a delay in claim payment:

  • A copy of the patient´s health insurance ID card
  • A copy of the claim submitted to the company for each patient and date of service
  • Evidence of claim submission in the form of:
    • Electronic transmission confirmation,
    • Certified mail return receipt, or
    • Courier delivery confirmation
  • Evidence of your collection activities for each claim prior to contacting TDI. That evidence should be in the form of:
    • Documentation of phone conversations made to the health carrier
    • Copies of correspondence mailed to the health carrier
    • Replies you have received from the health carrier

Be sure to separate claims by the HMO or insurance carrier name. Claims for one HMO or insurance carrier must be grouped together and alphabetized by the patient’s last name. If there is more than one claim for the same patient, please staple the claims together.  To find where to submit an insurance complaint to, check the list here.

For more information contact:


August 18, 2011

“Being a leader is like being a lady, if you have to go around telling people you are one, you aren’t.”  – Margaret Thatcher

What is CAQH?

August 15, 2011

The Council for Affordable Quality Healthcare (CQAH) is a nonprofit alliance of health plans and trade associations, working to simplify healthcare administration through industry collaboration on public-private initiatives.  CAQH’s mission is the improvement of healthcare access and quality for patients and the reduction of the administrative burden for healthcare providers and their staff.

Universal Provider Datasource (UPD) is an online provider data-collection service. It streamlines provider data collection by using a standard electronic form that meets the needs of nearly every health plan, hospital and other healthcare organization. UPD enables physicians and other healthcare professionals in all 50 states and the District of Columbia to enter information free-of-charge into a secure central database, then authorize healthcare organizations to access that information. UPD eliminates redundant paperwork and reduces administrative burden.

The detailed practice information that CAQH asks for helps ensure that UPD-participating health plans, hospitals, and other healthcare organizations can obtain all the information they need without having to conduct any follow up with physicians or other healthcare providers. The form’s broad scope also ensures that participating organizations can better maintain and improve provider directories and data systems. The online form only asks questions that are relevant to a particular specialty or provider type.

How do physicians and other healthcare professionals complete the CAQH application?  Completing the form requires five steps:

  • Registering
  • Completing the UPD Online Form
  • Authorizing UPD-participating Plan Access to the information
  • Verifying data entry/Attesting
  • Submitting supporting documentation

How to register: 

  • Go online to
  • Click “Logging in for the first time?”
  • Enter CAQH Provider ID
  • Enter authentication data
  • Create username and password (make sure you write down this login information and keep it in a safe place for future access)
Please note:
The CAQH system will prompt the provider to re-attest to the accuracy and completeness of the data every 120 days via email or fax using the primary method of contact information the provider has supplied in his/her CAQH record.  If a provider’s  record has not been attested to after a period of time, the status changes to expired and the data cannot be used for primary source verification.

What is the benefit of using CAQH?

90% of the National Health Insurance Companies use CAQH and in many cases it is a prerequisite for their enrollment process.  Since the information is compiled in an online database that stores provider information, this information is granted to health insurance companies to make acquiring provider information more efficient where they can directly pull from your file instead of contacting you directly for the necessary information.

Who can I contact for help or if I have a question about the process or service?

The CAQH Help Desk provides telephone service support for assistance with any questions you may have at 888.599.1771 from Monday thru Friday 7am to 7pm (EST).  To contact via email:  You may also visit for further information.


August 11, 2011

“No matter what accomplishment you make, somebody helped you.”  -Althea Gibson

Documents required for Credentialing process

August 8, 2011

What you will need to begin the Credentialing process:

To make this process even easier, we’ve developed the following checklist of items you’ll need to complete the application. Please gather the following information (if applicable) before you begin the online application:

  • Your CAQH Provider ID number (located on the cover letter from CAQH)
  • A previously completed credentialing application (if applicable)
  • A list of all previous practice locations
  • A copy of your Curriculum Vitae
  • A copy of your License
  • A copy of your DEA Certificate
  • A copy of your DPS Certificate
  • A copy of your IRS Form W-9
  • Various identification numbers (NPI, UPIN, Medicare, Medicaid, etc.)
  • A copy of your Malpractice Insurance Face Sheet, along with a summary of any pending and settled cases OR Professional Liability Coverage Sheet
  • Documentation of accreditation by TJC, CARF, AAAHC or CCAC or similar accrediting organization (if a Facility)
  • List of any  Medicare or Medicaid exclusions or sanctions
  • Any other pertinent information
You can print off a Check List for individual providers here.  The Texas Standardized Credentialing Application fulfills requirements of Senate Bill 544 (Acts 2001, 77th Leg., ch. 1369, §3, effective Sept. 1, 2001), providing for the Texas Insurance Commissioner to adopt a standardized form for verification of physician credentials.  Use of the application form by hospitals, HMOs and PPOs is required for credentialing of physicians. Hospitals and health plans may use this application for the credentialing of other health care professionals, as well.  The credentialing form is based on one developed by the Coalition for Affordable Quality Healthcare.  A Texas Standard Credentialing Application can be obtained here.


August 4, 2011

“Nobody can prevent you from choosing to be exceptional.”   – Mark Sanborn

Disciplinary Proceedings by the Texas Medical Board

August 1, 2011

By law, with certain exceptions the agency must complete the complaint and investigation process within 180 days, and the litigation process within another 180 days, so most complaints that are opened as investigations and go to litigation are resolved within a year (with the exception of cases that go to the State Office of Administrative Hearings). Disciplinary actions may include the following:

◆ an administrative fine for a minimal statutory violation, such as failing to provide properly requested medical records within 15 business days, or failing to get required continuing medical education;

◆ standard of care actions might require the respondent to have additional training, or monitoring by another physician;

◆ sexual misconduct violations may require boundaries courses or restrictions from treating the opposite sex;

◆ cases involving substance problems usually require a rigorous drug-testing program. Disciplinary orders can be as short as a one-time public reprimand or as long as 10 or 15 years of probation. Licenses may also be revoked or suspended if the Board determines the licensee’s continuing in practice is a threat to the public.

Out of the approximately 6,000 complaints TMB receives each year, the agency investigates about 2,000, and issues around 300 disciplinary orders each year.