Question Authorizations


San Antonio, TX
Best answers

I would like some input on how to create an authorization correctly once it has been denied/voided due to benefits maxed or no out of network benefits. Currently, I am told to enter "Max Benefits Reached," "Benefits Exhausted," or "No OON Benefits" as my Authorization Number, which of course gets printed on the claim form. I suggested putting the reference number of the denial as the authorization number since the claims processors will be able to see any notes affiliated with that particular reference number and deny accordingly. What is the best approach when dealing with these types of authorization denials? Thanks in advance.
This is more of a company workflow policy question. I don't really see an issue with either of the workflows if this is what your company has determined works best for you.
I am assuming in your situation, you tried to get authorization, it was denied, the patient was properly informed and agreed to pay for the services. You are billing the insurance just for the denial.
I will note that almost all claims are processed automatically by computer systems these days. The odds of your claim being looked at by a human who will enter the reference number to review the notes seem pretty slim.
At my company, the workflow unless it is an actual authorization number is to leave it blank. For some insurances, entering other information in that field will cause an automatic rejection (not a denial).