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Wiki No auth denials

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orthobiller2017

Networker
Messages
45
Location
East Northport, NY
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have providers that work for a partner hospital with an Emergency Dept. They often do trauma surgeries on cases referred to them from the ED but POS is 21. We get denied all the time for no authorization. Sometimes we have auth from the partner hospital but most times not and also sometimes the carrier will not honor the hospital auth since we are billing for the MD.. A lot of these cases are captured Medicaid plans. We tried modifier ET but that didnt work. We appeal with the documentation showing these are ED directed patients but most times no luck.
Any recommendations?
 
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