Health First, Inc. proves no referral needed
Provider: Health First, Inc.
Dollar Value: $4,323.00
Communication Event: Trace Voice
Challenge: Denial for lack of referral
Benefit: Recovery of $4K
A patient access representative used Trace to record a request for authorization for an outpatient procedure and to inquire if a referral was required. The payer responded that no referral was needed since the hospital was in-network and facility charges were covered without referral. The claim was processed and later denied for lack of referral. The hospital used the record to confirm that the payer said a referral was not required for an in-network provider. The payer processed the claim for payment, and Health First recovered $4,323.