A provider contacted the GIRS InContact Reimbursement Hotline® team for assistance with a denial of a claim.
After collecting the proper authorizations, the counselor reviewed the Explanation of Benefits (EOB), and was able to contact the payer to ascertain the reason for the claim being turned down, and the steps necessary to appeal the services to be reconsidered were collected as well. An appeals strategy was developed.
The counselor informed the provider of the denial, and of the steps that needed to be taken for the reconsideration of the claim. The counselor also advised the provider to verify the patient’s specific benefits before treating the patient to avoid denials. Tools for appealing the case were successfully given to the provider to appeal the claim. The provider was advised to appeal the claim until it was overturned.
The outcome of this case is that the provider now knows that patient benefits need to be verified with a payer before treating the patient. After two levels of appeal, the claims denial was overturned, and payment was made. The provider is now a regular customer, and feels now that he has a resource to assist him when there is an issue with a claim.
If your accounts are experiencing claims denials for your medical device, drugs, biologics, or diagnostics, the GIRS InContact Reimbursement Hotline can answer reimbursement questions, provide prior authorization and claims appeals guidance, conduct benefit verifications, and initiate other case specific inquiries to obtain positive coverage and appropriate payment for your product(s).
Please contact us by email or call us at 1-844-514-4477. Also, follow our LinkedIn Company Page for more bi-weekly news on reimbursement trends, milestones, and achievements.