Print Froggy Jumps: Authorizations (employee training - visio

1. If you have a claim that denied for no auth, what is the 1st thing you should check?

A

If the service requires an auth

B

The referral tab

C

the payer website

2. The no auth denial is not due to a credentialing issue if

A

the provider is seeing pts at the hospital

B

the payor says so

C

The plan requires the patient to select a PCP and they are seen by someone else.

3. The authorization number can be found on the claim in box

A

15

B

23

C

27b

4. If the office did get an auth, but it is not attached to the claim, you can...

A

write off the claim

B

attach it to the claim

C

send this information to Sandy

5. Where can you look to find an auth?

A

in the summary tab

B

in pt's registration

C

in pt's chart and referral tab and payer website

6. If a service denied for no auth and we are only billing with the professional service ( modifier 26), you will need to

A

research - not all services with 26 mod need an auth

B

remove the 26 modifier and resubmit claim

C

send to coding

7. What do you do when the cpt that was billed is slightly different than the cpt that was authorized? ( in the same family/ same area of the body)

A

Adjust as no auth.

B

Appeal with the payor utilizing the contract language on Managed Care website.

C

have the practice put the authorized code on the claim

8. where can you find the auth denials visio? ( flow chart that shows the steps of how to handle auth denials)

A

Experian

B

Auth B2B

C

Pt's chart