No pre-cert/auth

[RoVeada]

Hi All...

Happy Holidays. Hope all is well.

Has anyone had any success with getting retro auths or claims paid that denied for no auth/pre-cert? Im working some claims for a ASC.

Thanks

[rdmoore2003]

Depending on the reason that no precert was done prior, you may be lucky to have claim paid.   Submit the claim with a detailed letter of the situation, that may help.

[PMRNC]

If it was elective surgery, chances are slimmer it will be paid. You can look at situation for which the auth was not done and if there are other charges the patient is incurring due to the same problem then it's best to have patient call and get retro auth, they have better chance than you.   If the auth was not obtained due to an error by physicians office only then an appeal could be done, but changes are a bit slimmer of them giving the retro auth. I still have the best luck getting patient to call

[RoVeada]

Thank you! I guess the patients are the way to go. Some of them are over 9 months old, so I know it is a long shot.

[PMRNC]

Yeah def have patient try for you.. I will warn you you'll want to make them seem they are doing you the favor because depending on the plan and reason auth was not obtained you might not be able to collect from them.