TRACE Confirms Authorization
Provider: Sacred Heart Medical Center
Dollar Value: $1,751.00
Communication Event: Monitored Call
Challenge: Denial for lack of notification
Benefit: Recovery of $1,751
The admitting office used TRACE to record a call to a payer to confirm benefits and eligibility and authorization requirements for a recently discharged patient. The payer provided the benefits and eligibility information, along with a number to call for authorization. The hospital placed a second call to obtain the authorization number. The payer told the hospital to proceed in submitting the claim, saying authorization was not required due to the short length of the patient’s stay. After the claim was processed, the payer denied the claim for lack of notification. The hospital located the call record and sent a transcript of the recording to the payer. The payer overturned the denial, and hospital recovered $1,751.00.