Wiki Retro Auth Appeals

Sarahlukkarila

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Hello,

I work for a clinical lab and we are receiving denials for retro auths because we ware not submitting the authorization within the payer guidelines. Due to the fact that we are a clinical lab, it sometimes takes days before we can actually submit the authorization for the sample. Does anyone have any tips or guidance on how to appeal their way out of this?



Any input would be much appreciated!
 
Pull the medical policy from the payer and appeal based on medical necessity. Unfortunately, I will add that retro auths are not usually successful as the payer usually stands behind the fact that authorizations are to be done prior to service. They place the burden squarely on the provider with the exception being cases of emergency, usually deemed "life or limb" risk.
 
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