I know what these words mean, however, can someone tell me how I know when an auth or notification is required. When I've called or looked up patients eligibilty and benefits, I'm told they do not need pre-certification. Primary Insurance consistantly pays on claims for over 3 years!! Then, out of the blue I got a denial saying I should have gotten an authorizaton number. I called said we didn't have to get that on other claims, and then told that ALL the other claims were paid in error! Also, was told that ALL patients being treated in the home of the patient have to have a Care Notification/authorization. Is "place of service" something not looked at very closely in processing? I wonder if I should be requesting Care notification numbers for ALL patients. Patients I bill for are all treated in the home for PT, and OT. How could it possibly be that ALL claims were paid "in error"? I'm talking about thousands of claims.
And as Linda stated, they do pay in error a lot. That is why they do audits, and unfortunately recoup