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RCM Q&A 2 Missing Authorization Denial: Top RCM Technical Questions and Answers with Sample Notes - Missing Authorization denial

RCM Q&A 2: Top RCM Technical Questions and Answers with Sample Notes

 Question: How do you work on - Claim Denied for Authorization

Same Question instead of denial Interviewer can ask the question like Missing/invalid/Authorization/Notification/Pre-certification etc.,

 

Answer :

Step1 : The status of a claim can be found on the insurance company's website; but, for missing authorization denial scenarios, you must contact the insurance company for more information.

Step2 : Provide Physician and Claim related information with the rep

Step3: Ask rep May I know the claim received and denied date

Step4: Ask why you required authorization for this service/cpt code and do they see any authorization on the file for another hospital claim

Step5: If yes

Step6: Could you please send the claim back for reprocess with that authorization and check the authorization effective and end date

Step7: If No

Step8: Can we get the retro authorization for this service

Step9: If Yes

Step 10: Get the retro auth and ask them to send the claim back for reprocess with that auth# else and get the time limit for retro authorization

Step 11: If No

Step 12: whether we can submit / appeal claim with MR notes. Appeal limit and fax # and address

Step 13: May I know the claim# and reference #

If you need to answer all the above mentioned steps with the interviewer

 

Sample Notes : Checked Claim status In insurance web portal found claim denied for Missing Authorization hence called insurance and spoke with Sam for Dos mm/dd/yyyy Stated claim was received on mm/dd/yyyy and denied for missing Authorization . Found authorization available for another hospital claim. Hence requested the Rep take the claim for reprocess. Clm#12345 . Ref# 54321

 

Please forward this blog to any of your friends who are scheduled to attend an important interview.


 

Comments

  1. Medical bill codingApril 12, 2022 at 3:24 AM

    insurance billing and coding
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