Precertification/authorization

[TXBiller]

We have a claim that was denied for lack of precertification/authorization. We reached out to the patient who said she would get the information and send it to us.  Now she fails to answer our calls.  Do I have to write this off or can I reduce the fees to the allowable amount and bill the patient?

[Eyore]

Precertification/authorization is a Provider responsibility (in our office) when verifying the patient's insurance.

United Healthcare for example Login, enter the Group number, and a notice appears with authorizations required or no authorizations required. There is an 800 number for Providers to call and ask prior to visits also.

[Michele]

If it is a referral then the patient must get it, but Eyore is correct, preauth is provider responsibility.

[mandaree23]

When in doubt, bill according to the EOB patient responsibility.  If it was a provider error then most times the EOB will not put to patient responsibility.

[PMRNC]

I never use the EOB to tell me if it's patient responsibility or contractual adjustment unless it's Medicare/Medicaid. They are not always accurate.