$44K Saved with Monitored Call
Provider: Large Children’s Hospital in Georgia
Dollar Value: $44,468.25
Communication Event: VoiCert - Monitored Call
Challenge: Denial for Lack of Precertification
Benefit: Recovery of $44,468.25
A patient access representative initiated a monitored call to verify
benefits and confirm that a precert was on file for an outpatient surgery.
The benefits representative confirmed that the patient was active and
that a precert was required for the procedure. Upon transfer to the
precert line, another insurance company representative confirmed that
the physician's office had a precert on file for the procedure.
The claim was processed, and payment was denied for lack of
precertification. The access representative used TRACE to locate a record
of the monitored call and sent documentation to the insurance company
to show that the precert had been confirmed on the initial call.
After reviewing the TRACE documentation, the insurance company
overturned the denial and reprocessed the claim for payment.