DENIAL-AUTHORIZATION

AUTHORIZATION DENIAL – PLACE OF SERVICE 21 / 22 (INPATIENT / OUTPATIENT)

HOSPITAL CLAIM AVAILABLE WITH AUTHORIZATION –

Cld ----- @ -------- , spoke with -------- said claim was denied on -------- for no authorization. Found no authorization listed in system and services were related to inpatient (21) / outpatient (22). Inquired with representative if they have the hospital claim on file since it would have the authorization# and our services should be covered under hospital authorization, rep researched and stated hospital claim has the authorization and sent the claim back for reprocessing. Also, obtained the authorization# -------  / rep was unwilling to provide the authorization#. Rep suggested to allow ------ days for reprocessing, Ref# ----------. Claim# ------- .

THINGS TO DO –

CLOSE PS DM 1 – AUTH/REFERRALS TASK

HOSPITAL CLAIM AVAILABLE WITH NO AUTHORIZATION

Cld ----- @ -------- , spoke with -------- said claim was denied on -------- for no authorization. Found no authorization listed in system and services were related to inpatient (21) / outpatient (22). Inquired with representative if they have the hospital claim on file since it would have the authorization# and our services should be covered under hospital authorization, rep researched and stated they have the hospital claim however even hospital claim does not have an authorization#. Claim# ----------.

Please verify if authorization# was obtained for this date of service? If yes, please update the authorization# and rebill all the line items and type corrected claim in the narr/dunn field of the charge screen. If no, please advise what would you want us to do with the balance?

THINGS TO DO –

RAISE CLT 1 – AUTH/REFERRALS

CLOSE PS DM 1 – AUTH/REFERRALS

HOSPITAL CLAIM NOT AVAILABLE –

Cld ----- @ -------- , spoke with -------- said claim was denied on -------- for no authorization. Found no authorization listed in system and services were related to inpatient (21) / outpatient (22). Inquired with representative if they have the hospital claim on file since it would have the authorization# and our services should be covered under hospital authorization, rep researched and stated they do not have the hospital claim on file. Claim# ----------.

Please verify if authorization# was obtained for this date of service? If yes, please update the authorization# and rebill all the line items and type corrected claim in the narr/dunn field of the charge screen. If no, please advise what would you want us to do with the balance?

THINGS TO DO –

RAISE CLT 1 – AUTH/REFERRALS

CLOSE PS DM 1 – AUTH/REFERRALS

REP UNABLE TO VERIFY IF THEY HAVE HOSPITAL CLAIM OR NOT –

Cld ----- @ -------- , spoke with -------- said claim was denied on -------- for no authorization. Found no authorization listed in system and services were related to inpatient (21) / outpatient (22). Inquired with representative if they have the hospital claim on file since it would have the authorization# and our services should be covered under hospital authorization, rep was unwilling to say if they have the hospital claim or not and advised we need to obtain the authorization from hospital and rebill the claim. Claim# ----------.

Please verify if authorization# was obtained for this date of service? If yes, please update the authorization# and rebill all the line items and type corrected claim in the narr/dunn field of the charge screen. If no, please advise what would you want us to do with the balance?

THINGS TO DO –

RAISE CLT 1 – AUTH/REFERRALS

CLOSE PS DM 1 – AUTH/REFERRALS