NO AUTHORIZATION SCENARIO IN MEDICAL BILLING : DENIAL MANAGEMENT : AUTHORIZATION REQUIRED

#AUTHORIZATION REQUIRED SCENARIO IN MEDICAL BILLING
#AUTHORIZATION: An approval requested (by doctor) from insurance/payer.
#PRE or PRIOR AUTHORIZATION : An authorization obtained from insurance before treatment.
#RETRO AUTHORIZATION: An authorization requested from insurance after treatment done.
#PRE ANALYSIS ON DENIED MEDICAL CLAIM: While we working medical claim we need to check from our whether we have authorization number in our billing software or not. If we authorization then verify with insurance representative whether it is valid auth or not. If auth# is valid, request claim for reprocess and if authorization is not valid, appeal with complete medical records. if in further appeal upheld, adjust the claim balance as no authorization found.
#We have to check all possibilities to get authorization on previous date of services rendered.
#EMERGENCY SERVICE DOES NOT REQUIRE AUTHORIZATION
#PLACE OF SERVICE 23 or EMERGENCY ROOM SERVICES does not require any authorization.
#Simple here insurance trying to deny the payments but as AR associate we should try to get the payments to the doctor or provider or physician.
#DENIAL MANAGEMENT
#PRE AUTH
#RETRO AUTH
#AR IN HEALTHCARE IN MEDICAL BILLING.
NO AUTHORIZATION SCENARIO DETAIL INFORMATION.
WHAT IS AUTHORIZATION.
WHAT IS PRE AUTH.
WHAT IS RETRO AUTH.
WHAT IS INPATIENT
#Reason for invalid authorizations:
AUTH IS NOT VALID FOR DATE OF SERVICES,
AUTH IS EXCEEDS THE DATES,
AUTH IS INVALID BECAUSE PROVIDER NAME LISTED ON AUTHORIZATION WAS NOT SAME ON BILLED CLAIM or FILED CLAIM.
AUTH IS NOT VALID FOR BILLED TAX ID means is valid on diff tax id.
AUTH IS DISALLOWED FOR INPATIENT STAY BECAUSE SERVICE WERE RENDERED AT LOWER LEVEL OF CARE that is SAME DAY SURGERY or ONE DAY SURGERY or Ambulatory surgical center.
AUTH IS DISALLOWED BECAUSE NOT BEEN MEDICALLY NECESSARY FOR INAPTIENT SERVICE RENDERED.
CLAIM DENIED FOR AUTHORIZATION BECAUSE LISTED AUTHORIZATION NUMBER IS NOT AUTH BECAUSE IT IS REFFERAL.
#WHAT KIND OF SERVICES REQUIRED AUTHORIZATION:
Inpatient services required authorization.
MRI scan codes required authorization.
Cardiology services required authorization.
Keep in mind that HIGH DOLLOR claims generally required authorization.
#AUTH.