NO REFERRAL DENIAL IN MEDICAL BILLING #denialmanagement #medicalbilling #hospital #insurance #claim

NO REFERRAL SCENARIO IN AR DENIAL MANAGEMENT
https://youtu.be/tE-IZvFuqOU
RECOMMENDATION: Referral is an approval provided by PCP to the client to speak with an expert medical professional.
HMO * strategy needed Referral from PCP.
Contact us to an insurer and supply the recommendation # over the call & verify stands or not. If recommendation stands, recycle the claim.
If recommendation is not legitimate, ask the insurance coverage representative and get the information like PCP NAME, SPECIALITY & PCP PHONE #.
Ask the insurance coverage agent for fixed claim mailing address to send the claim with legitimate recommendation acquired. Get claim’s appeal mailing address to send out an appeal if no recommendation needed for billed services.
Get claim #, call ref # & close the call.

ACTIONS:
Recycle the claim over the telephone call. (IF recommendation stands).
Recycle the claim over the telephone call. (If client strategy is PPO.)
Send the fixed claim. (After acquired the legitimate recommendation # ).
Send out an appeal (if verified that billed services does not needed any recommendation).
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https://medicalbillingcertificationprograms.org/no-referral-denial-in-medical-billing-denialmanagement-medicalbilling-hospital-insurance-claim/