Medical Billing Forum

General Category => General Questions => Topic started by: Nmanju on October 29, 2009, 06:03:53 AM

Title: Referral exhausted
Post by: Nmanju on October 29, 2009, 06:03:53 AM
Hi,

I have a question. I have a claim which got denied stating the Maximum number of visits authorized have been exhausted on the given referral. And my q is, what should be done in such case. Do we need to call insurance or PCP clinic to add more visits on the same referral. Waiting for UR advice.


Thanks in advance.


Manju
Title: Re: Referral exhausted
Post by: Pay_My_Claims on October 29, 2009, 10:20:33 AM
depends on the insurance. Some can extend it.
Title: Re: Referral exhausted
Post by: Michele on October 29, 2009, 06:41:07 PM
Yes, depends on the insurance and also on the type of service.  Sometimes the provider needs to send in a treatment plan to request more visits, sometimes the PCP needs to do another referral.

Michele
Title: Re: Referral exhausted
Post by: NuBiker on November 01, 2009, 02:57:31 PM
When we were using a billing service, we got the biller a password into each of our insurance websites.
With some of them, like UBH, it's really easy to get an Auth for more visits. Other insurances require the doc to submit paperwork, or at least talk to a case worker.
Title: Re: Referral exhausted
Post by: Nmanju on November 02, 2009, 08:33:47 AM
so can we register online on insurance website?
Title: Re: Referral exhausted
Post by: Pay_My_Claims on November 02, 2009, 11:18:33 AM
so can we register online on insurance website?

OMG yes!! I have access to anything that will verify, precert, claim check, or send a claim. ONline access ROCKS!
Title: Re: Referral exhausted
Post by: PMRNC on November 02, 2009, 11:21:09 AM
I agree, but I'm not sure if it's just ME or what, but I STILL find the phone more reliable and fast.
I did an analysis a few months ago and actually saved 2.5 hours using the phone rather than internet. :)  I'm not sure if that is overall in the industry or just plain luck ? I will always pick up the phone first.  I do like the online access for certain things and sometimes it's handy after hours.
Title: Re: Referral exhausted
Post by: Michele on November 02, 2009, 01:22:19 PM
I find some websites are better, but some it is definitely quicker, easier and more reliable to use the phone.   :)

Michele
Title: Re: Referral exhausted
Post by: Pay_My_Claims on November 02, 2009, 02:55:24 PM
Now on certain specialties I can agree, but when I did inpatient/outpatient admissions. Online was the way to go 100%. Working DME is about 80% because of the specific codes and being out of network. In net I would say about 90% good.  I'm just the type to remember group numbers and learn policies and payor requirements based upon that. This is why I want to stay in DME. I know doing more specialties makes me marketable, but I also find most services don't bill DME.