NO REFERRAL DENIAL IN MEDICAL BILLING #denialmanagement #medicalbilling #hospital #insurance #claim

NO REFERRAL SCENARIO IN AR DENIAL MANAGEMENT    • NO REFERRAL DENIAL IN MEDICAL BILLING #den...   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.