NON specialized chart reviewer

PLAIDMAN

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One of our payors use a company to do their "chart review" for surgeries

We send our op reports to this company - and they determine if the documentation supports codes submitted and they tell the payor to pay/deny claim

My problem is they use a Urologist to review (and deny) my ortho surgeries....I have literally photocopied the dictionary with definitions & anatomy and have gotten the claim paid

Any secrets on how to require a reviewer to use Ortho MD on ortho claims ? my specialist has to be special.....their specialists are not special - this is a time waster !

thx
 
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