When primary has denied for no auth

myndi13

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I am just curious about a particular situation. We had an acute patient whose primary insurance denied for no authorization so the secondary insurance was billed with the denial. The secondary came back with patient responsibility, which if the primary hadn't denied would have been much less if not zero. My question is should the secondary have been billed or should the entire amount of the claim adjusted off due to the denial from the primary? The balance that is being billed to the patient is what the secondary is stating is patient responsibility. :confused:
 

CodingKing

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I would say its a write off for sure if you were aware of the patients primary carrier are contracted and failed to obtain authorization.
 
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I agree that if it's denied for no auth, it would be a write off, unless the payer will permit you to do a retro-auth (which is far and few between).

In order to bill the secondary, or even the patient, the primary payer's EOB would have to deny to patient responsibility.
 
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