Insurance claim denied as pre-authorization required

Authorized services provided to the member must be reflected on the claim as agreed to during the authorization process. Procedure codes, frequency, amount, and duration of services must exactly match the information in the authorization. If a medical need for a different service is identified, contact Utilization Management to change or update the authorization prior to the
provision of services.

IMPORTANT: Only services specifically authorized will be considered for reimbursement. hospitals, physicians and health care professionals may include a written description of services in addition to the appropriate HCPCS or CPT codes as an aid in identifying authorized services. Although an authorization number is indicated on the claim, if the services billed do not match the authorization, the claim will be denied.

The service provider (i.e., the physician, health care professional or facility) on the claim must match the practitioner of facility authorized for the service. Inconsistencies may result in inaccurate payments or denials.

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1 comment:

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