Hey , I have worked with RCM as an AR follow up but due to a year gap of same profile i was lacking in some terms ,however your all videos cleared my most of the doubts .. Thanks a ton for sharing your knowledge with us...dude... ❤keep.it up keep growing
Your explanation is easy to understand, so can you explain about AOB and ABN?. Why didn't you post medical billing video for last 2 years, keep it up sir we will support you.
It's nothing the patient under emergency situation with a valid reason can go for high cost surgery or any other medical purpose without Authorization and the later you get auth from respective insurance to submit the claim and process.
Appeal is a final hope of claim processing.. we submit med recs stating we did these all services to patient. Sometimes we may receive partially payment
A claim that has not been paid due to TFL (Timely Filing Limit) means if the perticular date has surpassed the given date and the provider failed to take the response from the Payer or the Patient can be called a denial claim. It's a loss to the provider the payment will write-off in this case.
For authorisation denial...we can't send a corrected claim...as the doctor or some one in the hospital should have been got the authorisation from the insurance company prior to the service rendered....so the only way we can get the claim to be process is appealing with medical records....or if any retro authorisation (i.e) getting an authorisation after the service was rendered sometimes they may have a portal to get retro authorisation and if no we need to ask whether any hospital authorisation active for that date of service...if this is also no...appealing with medical records or any documents needed by the insurance companies will be done ☺✌
@@joltil-joyoflittlethingsin3756 If claim was denial fir pre auth is not on file and the provider is given a appeal with attached med rec than we need to check
![DENIAL REASON [CO 29] - TIMELY FILING LIMIT EXCEEDED [denial management] in medical billing](http://i.ytimg.com/vi/zbx7OXLgDM8/mqdefault.jpg)
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![prior or pre Authorization - [denial management] in medical billing](/img/n.gif)
Excellently described the whole call process. thanks keep making more informative videos
Wow, Great calling sample video, if you continue the same for more denials will be helpful for ppl more.
huge help. thank you. keep it up
Please make more videos . I like your videos.
Awesome and easy to understand❤❤
Hey , I have worked with RCM as an AR follow up but due to a year gap of same profile i was lacking in some terms ,however your all videos cleared my most of the doubts ..
Thanks a ton for sharing your knowledge with us...dude... ❤keep.it up keep growing
i can understand easliy please keep it up more denial mock call its very helpful
It somehow same with aetna claims. Hope you'll have an example of it.
Excellent!
Brilliant
good job. but you miss you took claim#
alright thank you for sharing info/knowledge
Nice
Your explanation is easy to understand, so can you explain about AOB and ABN?. Why didn't you post medical billing video for last 2 years, keep it up sir we will support you.
Good job bro 🤜
Keep it up
Amazing 🤩🤩
Keeping going bro.. 👍
Check place of service before retro auth.
I have recently joined medical billing company they are giving me eligibility cases can you tell me how to review claim. And what to ask on call?
Super👏👏👏👏👏👏
what kind special office visits need authorization
Thanks for this!
You're welcome 🙂
Mam you missed to probe a question, once the resp says Retro auth is NA ( YOU SHOULD ASK - IS THERE ANY HOSPITAL AUTH ACTIVE FOR THAT DOS). ADD THIS
@A A,
Yes, you are correct. Thank you!
Currently on Healthcare industry
Long time no see, where have you been bro ?
I am confused in retro auth, never worked on that.
Can you make a video on that
It's nothing the patient under emergency situation with a valid reason can go for high cost surgery or any other medical purpose without Authorization and the later you get auth from respective insurance to submit the claim and process.
Retro auth based on the policies of insurance not matter if u submit all MRs (Office 11) service
What in case if we bill the claim with pos 23, and still denial the claim for auth?
Emergency services does not require authorization, you need to call and get it reprocess.
Is hospital billing and medical billing are same?
I'd love the reps would be so kind hahaahahaha they use to throw the phone once you have send the claim back to reprocessing
Good job 👍🏻
Any Authorization Analyst jobs bro...
Claim number?
You didn't ask for claim number
Make new video am waiting
As you said we need ask claim number and call ref number. In this mock you totally forgotted to take claim#.
U don't forget
Retro auth is not possible. Is it possible to send appeal letter.
Appeal is a final hope of claim processing.. we submit med recs stating we did these all services to patient. Sometimes we may receive partially payment
@@dminmb Thank u
Forgot to take the claim#
What is the denial?
A claim that has not been paid due to TFL (Timely Filing Limit) means if the perticular date has surpassed the given date and the provider failed to take the response from the Payer or the Patient can be called a denial claim. It's a loss to the provider the payment will write-off in this case.
Y do we need appeal address when claim is denied completely
For authorisation denial...we can't send a corrected claim...as the doctor or some one in the hospital should have been got the authorisation from the insurance company prior to the service rendered....so the only way we can get the claim to be process is appealing with medical records....or if any retro authorisation (i.e) getting an authorisation after the service was rendered sometimes they may have a portal to get retro authorisation and if no we need to ask whether any hospital authorisation active for that date of service...if this is also no...appealing with medical records or any documents needed by the insurance companies will be done ☺✌
@@joltil-joyoflittlethingsin3756 and what remarks should we write on the appeal letter?
@@ravikhatri8922 i dont have experience in sending an appeal letter
@@joltil-joyoflittlethingsin3756 If claim was denial fir pre auth is not on file and the provider is given a appeal with attached med rec than we need to check
Many questions missed
Humana reps are Indians though.... lol
That was a mock call not a real call recording