Wiki Not authorized

[ajamieson458]

When a claim from 4/2/2016 is denied for not being authorized, don't we have to write it off?

 

[thomas7331]

If your provider is contracted with the payer then in most cases you will be required to write this off, but it really depends on the terms of the contract and of the member's benefit plan. The EOB with the denial should state whether the balance is provider or patient liability. If it is a commercial payer with which you do not have a contract, then you are not required to write off the balance.

 

[avon4117]

I would check to see if you can get a retro auth..if not..I would appeal it based on medical necessity.