Auth

1. If you receive the status on call as the claim is denied for authorization absent or missing and you find the authorization in your system then what will be your next question?

• What is the time limit to send a corrected claim?
  

• I have the Auth#, Can you please reprocess the claim using this Auth#?
  

• What is turn around time for processing?
  

• None of the above

2. If you receive the status on call as the claim is denied for authorization absent or missing and you find the authorization in your system and the rep agrees to reprocess the claim then what will be your next question?

• What is the time limit to send a corrected claim?
  

• I have the Auth#, Can you please reprocess the claim using this Auth#?
  

• What is turn around time for processing?
  

• None of the above
  
  

If you receive the status on call as the claim is denied for authorization absent or missing and you find the authorization in your system and the rep denies to reprocess the claim and asks to send the corrected claim then what will be your next question?

• What is the time limit to send a corrected claim?
  

• I have the Auth#, Can you please reprocess the claim using this Auth#?
  

• What is turn around time for processing?
  

• None of the above
  
  

4. If you receive the status on call as the claim is denied for authorization absent or missing and there is no authorization in the system and the service is an emergency service then what will be your next question?

• Do you have Auth# on file? OR Is there any hospital claim billed on same DOS where authorization# present?
  

• Could you please use that Auth# and send claim back for reprocessing?
  

• Could you please reprocess the claim since it is an emergency service & does not require Auth#?
  

• None of the above

5. If you receive the status on call as the claim is denied for authorization absent or missing and there is no authorization in the system and the service is not an emergency service then what will be your next question?

• Do you have Auth# on file?
  

• Could you please use that Auth# and send claim back for reprocessing?
  

• Is it possible to obtain Retro Authorization#?
  

• None of the above
  
  

6. If you receive the status on call as the claim is denied for authorization absent or missing and there is no authorization in the system and the service is not an emergency service and the rep finds the Auth# in their system or on the hospital claim then what will be your next question?

• What is the fax# or mailing address to send an appeal?
  

• Could you please use that Auth# and send claim back for reprocessing?
  

• Is it possible to obtain Retro Authorization#?
  

• None of the above
  
  

7. If you receive the status on call as the claim is denied for authorization absent or missing and there is no authorization in the system and the service is not an emergency service and the rep is unable to find the Auth# in their system or on the hospital claim then what will be your next question?

• What is the fax# or mailing address to send an appeal?
  

• Could you please use that Auth# and send claim back for reprocessing?
  

• None of the above
  
  

• Is it possible to obtain Retro Authorization#?
  

8. If you receive the status on call as the claim is denied for authorization absent or missing and there is no authorization in the system and the service is not an emergency service and the rep is unable to find the Auth# in their system or on the hospital claim but obtaining retro authorization is possible then what will be your next question?

• What is the procedure to obtain retro Auth#?
  

• What is the fax# or mailing address to send an appeal?
  

• How much is the time limit?
  

• None of the above
  
  

9. If you receive the status on call as the claim is denied for authorization absent or missing and there is no authorization in the system and the service is not an emergency service and the rep is unable to find the Auth# in their system or on the hospital claim and obtaining retro authorization is not possible then what will be your next questions?

• What is the fax# or mailing address to send an appeal?
  

• How much is the time limit?
  

• May I have the claim# & call ref#?
  

• All of the above
  
  

10. If the claim is denied for authorization absent or missing and Auth# is available in the system but the rep denies to reprocess the claim and asks to send the corrected claim then what will be your action?

• Submit the corrected claim
  

• Write off the claim
  

• Set the follow-up for the TAT
  

• None of the above