Proof Point | The White Stone Group, Inc.

TRACE Settles Billing Dispute at Texas Hospital

Provider: Texas Hospital
Dollar Value: $15,834.25
Communication Event: VoiCert
Challenge: Billing Dispute
Benefit: Recovery of $15,834.25

An insurance verifier at a Texas hospital used TRACE to record a call to verify authorization for an inpatient stay. The payer responded with an authorization number for the dates of service. The payer processed the claim and issued a denial, stating that the authorization should have been obtained from behavioral health instead of the medical side. The hospital submitted a transcript of the call record with an appeal to settle the dispute. They recovered $15,834.25 of the claim for $26,739.00.