NO REFERRAL DENIAL IN MEDICAL BILLING
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- เผยแพร่เมื่อ 20 ก.ย. 2024
- NO REFERRAL SCENARIO IN AR DENIAL MANAGEMENT
• NO REFERRAL DENIAL IN ...
REFERRAL : Referral is an approval given by PCP to the patient to consult a specialist doctor.
HMO * plan required Referral from PCP.
Call to an insurance company and provide the referral# over the phone call & confirm is valid or not. If referral is valid, reprocess the claim.
If referral is not valid, ask the insurance rep and get the details like PCP NAME, SPECIALITY & PCP PHONE#.
Ask the insurance representative for corrected claim mailing address to submit the claim with valid referral obtained. Also get claim’s appeal mailing address to send an appeal if no referral required for billed services.
Get claim#, call ref# & close the call.
ACTIONS:
Reprocess the claim over the phone call. (IF referral is valid).
Reprocess the claim over the phone call. (If patient plan is PPO.)
Submit the corrected claim. (After obtained the valid referral# ).
Send an appeal (if confirmed that billed services does not required any referral).
For more ...Please subscribe now my channel now and hit bell icon for more new updates . Thank you for your time. Have good health.
Sir! First of all thank for you making this video, it was easy to understand but still have two doubts. My first question is if the POS is 23 (Emergency Room Hospital), and the patient's plan is HMO, do we still require a Referral number? My second question is if no referral number is available and if I get the PCP's information who is responsible to call the PCP? Should the AR caller do so or any other backend team is responsible or it's from the provider side. What would be the documentation needed to type while working on this denial? At least try to post the end action notes after getting PCP information.
Thank you and welcome you. For Emergencie services (Pos23) does not required any Authorizations and referrals (even though pt has HMO plan). As a AR caller you don't do any call to PCP, just put pcp details n task to client review/ or follow your process updates.
Thank you so much sir I'm getting enough info through your videos
Welcome you
These vedios are so helpful. Kindly make vedios of website where we check the eligibility and coverage of insurance. Like atena, BCBS. Website like navinet, avility, mertina, uch, procoder etc.
Sure I will do. Thank you for your support Kumar.
truly very neat explanation for AR people...gd channel
Thank you Hari Krishna 🤝
Very helpful 👍 information thanks
Welcome you
Subscribed
You are good teacher sir.. ।so helpful. .
Thank you Shiva
Sir please help me to how to read or analyse eob.
Sure
Hi
can I put 2 years experience
To get 4 lakhs package
@@nagesh2624 yes you can get it
@@PKRVibesCareerGrowth nenu TH-cam lo oka channel chusanu a r caller training 15 days all Denial paina work scenario explain chesthunaru experience petti vellocha direct ga
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In which box we need to put PCP Referral? CMS 1500
Hello Ritesh Ghosh, welcome to my Channel. We can put REFERRAL#, prior Authorization#, mammography pre- certification# , CLIA# in the BOX#23
@@PKRVibesCareerGrowth Thanks! But if we have Auth same time We need Referral! How do we put these two in one time?
@@riteshghosh8229 it's very rare. In that case we can go for BOX#19 (Reserved for local use additional information)
@@PKRVibesCareerGrowth Thanks man 🙂
Denial Code?
PR 288
Ur videos helps me a lot in my life. While seeing in ur videos I leant so many things thank you so much for you quick doubt clarification ❤️