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September 27, 2013

Article: Insurer Won’t Pay, Says Auth Wasn’t Provided? Prove Otherwise!

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Patient access departments are seeing increasing numbers of claims denied due to lack of authorization, even when the authorization was, in fact, obtained. By recording calls, registrars at Martin Memorial Health Systems were able to get payment for a $12,000 denied claim.

To successfully appeal denials:

  • Record all phone calls with payers.
  • Be able to prove you left a message after hours.
  • Specify whether the authorization is for outpatient or inpatient status.

Read the full article from Hospital Access Management here.

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