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Denial for 88305


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I just started working for a billing company; one of the accounts is an Oral Pathologist. They receive denials for no prior authorization and/or out of network for CPT 88305. If the surgeon or dentist send a speciman to confirm the absence /identification of disease and the patient is not aware at the time.

1.how would the know to get prior auth

2.who's responsible for choosing the in network lab??? ......

I want to appeal but I'm not sure where to start....HELP!!
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