Access departments in conjunction with patient financial services receive multiple benefits and authorization denials. Claims with denials for lack and/or, improper authorization are pervasive in the industry and usually are uncollected. HLS believes that when providers treat patients in good faith, they deserve to be reimbursed for those services. When a procedural roadblock such as lack of insurance information prevents the hospital from obtaining authorization in a timely manner, payers should not use that as a pretext to deny medically necessary services.
Sample Issues appealed:
- No authorization
- Improper authorization
- Referrals
- No coverage
HLS attorneys and professionals have succeeded in overturning benefit and authorization denials by persuading getting payers to grant retroactive authorizations, to extend existing authorizations to include different dates or codes, and to reprocess claims that incorrectly denied for lack of authorization due to an error on the payer’s part. We bring together our knowledge of statutory authorization requirements and payer-by-payer authorization guidelines, as well as facts gathered from provider notes, medical records, and information from the payer to demonstrate that the denied services should be paid.
