Proof Point | The White Stone Group, Inc.

TRACE Overturns $5K Denial

Provider: Huguley Memorial Medical Center
Dollar Value: $4,946.20
Communication Event: PC Call
Challenge: Denial for lack of pre-authorization
Benefit: Recovery of $4,946.20

The hospital used TRACE to record a call to a payer to determine if authorization was required for an outpatient CT scan. The payer replied that the planned procedure did not require authorization. The claim was processed and denied due to lack of authorization. The hospital located the call record and sent the payer a transcript of the recording as part of the appeals process. The payer overturned the denial and paid the claim. The hospital recovered $4,946.20 of the original denial for $6,082.75.