NEW AUTHORIZATIONREJECTIONS

Copy of the new no authorization letter

Subject: No Authorization on file for DOS and/or Procedure Code

 

Service Date: 09/02/2009

Patient: Jane Doe

Payer Name: Altius/CHP

We have received information on the above mentioned patient and have found one or more errors on your claim. Your claim has been deleted from our system. Please be aware that delaying the corrections will only lengthen the return of payment on your claim. Please make the appropriate corrections and resend the claim.

 Please research the problem by verifying whether your office has auth by following these simple steps:

1. Recount the visits billed and make sure there is enough auth.

2. Did you receive authorization after you sent the claims?

3. Pull the name up in your practice management software and the AHS web site, compare all personal data. Two of the more common problems are: a. Name (flip-flopped first and last names, middle initial in the first name field, hyphenated last names,

etc) b. DOB (entered incorrectly)

4. Check the policy timeframe. For example, if the no auth letter is regarding an Altius patient and their policy runs from September to August and the DOS is for 9-15-08, you should ask yourself: 'Do I have auth beginning with the new policy year?' If you do not, please request additional visits.

5. You may have failed to request authorization for the second x-ray code, or other procedure code which requires authorization.

Remember all claims must be resent after the error is fixed whether the error is in your practice management software or the Allied website. This only applies for claims submitted after 9-1-2009.

 

Sincerely,

CHP Claims Management

New Rules

If the DOS does not have authorization at the time the claim is received the DOS will not be allowed into CHP’s system, you will receive an email.

Possible errors and how to correct:

1. If your office failed to obtain authorization simply request the authorization and resend the claim.

2. If authorization is on file but there is a clerical problem either in the practice management software and/or Allied Website. Fix the error and resend the claim. Remember name and DOB must match exactly.

3. The website now allows you to fix most of the information yourself. Very few items will require creating a ticket.

4. If you failed to get authorization on procedure codes that require additional authorization, you will need to obtain the procedure authorization and resend the entire DOS not just that line item.

Rebilling your claim

Remember when rebilling your claim, if multiple DOS were attached to the same bill and only 1 DOS had the authorization problem you will get a duplicate letter on the other DOS if rebilled in a group.

For Example: DOS 9-10-09, 9-12-09 and 9-20-09 were all billed

together as bill 1. DOS 9-10 and 9-12 were accepted and released to the carrier. DOS 9-20-09 did not have authorization and was rejected. To fix this you should rebill only DOS 9-20-09 or if you choose to rebill the entire claim be prepared to receive a duplicate letter on DOS 9-10 and 9-12-09.

997/277 Error Report

If errors exist in a batch sent to CHP your 997 will report ACCEPTED but with errors noted

The errors will appear on your 277 at line level.

It is very important that the doctors chpdc.com email accounts are checked daily, research any problems and claims are re-billed in a timely manner.