Suggestions/Expertise on Topic

Aristotelis Panousis Assistant Manager

Description

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
 
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Citation

Aristotelis Panousis Assistant Manager, “Suggestions/Expertise on Topic,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 1, 2024, https://library.drfop.org/items/show/237461.