Suggestions/Expertise on Topic
Aristotelis Panousis Assistant Manager
Description
Collection
Title:
Suggestions/Expertise on Topic
Creator:
Aristotelis Panousis Assistant Manager
Date:
6/14/2015
Text:
We recently had one of our new admin staff do an insurance verification on a patient's insurance. When our admin staff asked the insurance representative about the plan, she asked these following questions:
She asked, “Are the codes covered and billable.” The representative answered, “Yes.”
She asked, “Does this plan follow Medicare Fee Schedule and Medicare policy/Guidelines.” The insurance representative answered, “Yes.”
However our admin staff did not ask if this plan required prior authorization, because the insurance representative informed her that this plan followed Medicare policy/guidelines.
When we received the EOB for this claim we were denied, because of not receiving prior authorization on the claim. We tried pre-dating the authorization with the insurance, but that was not a success. Can we do a prior authorization now and bill it again as a whole new claim? If anyone has any expertise on this topic, we would greatly appreciate it.
Thank you,
Aristotle
Assistant Manager
The information in this message may be proprietary and/or confidential, and protected from disclosure. If the reader of this message is not the intended recipient, or an employee or agent responsible for delivering this message to the intended recipient, you are hereby notified that any dissemination, distribution or copying of this communication is strictly prohibited. If you have received this communication in error, please notify Bionic Prosthetics & Orthotics immediately by replying to this message and deleting it from your computer.
She asked, “Are the codes covered and billable.” The representative answered, “Yes.”
She asked, “Does this plan follow Medicare Fee Schedule and Medicare policy/Guidelines.” The insurance representative answered, “Yes.”
However our admin staff did not ask if this plan required prior authorization, because the insurance representative informed her that this plan followed Medicare policy/guidelines.
When we received the EOB for this claim we were denied, because of not receiving prior authorization on the claim. We tried pre-dating the authorization with the insurance, but that was not a success. Can we do a prior authorization now and bill it again as a whole new claim? If anyone has any expertise on this topic, we would greatly appreciate it.
Thank you,
Aristotle
Assistant Manager
The information in this message may be proprietary and/or confidential, and protected from disclosure. If the reader of this message is not the intended recipient, or an employee or agent responsible for delivering this message to the intended recipient, you are hereby notified that any dissemination, distribution or copying of this communication is strictly prohibited. If you have received this communication in error, please notify Bionic Prosthetics & Orthotics immediately by replying to this message and deleting it from your computer.
Citation
Aristotelis Panousis Assistant Manager, “Suggestions/Expertise on Topic,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 29, 2024, https://library.drfop.org/items/show/237461.
