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Wiki Aetna Better health

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Diptigadiya

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Monmouth Junction, NJ
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Hello,
Biller

I currently started a New job as a Biller for ophthalmologist . Aetna better health medicaid denied my claim for 92015 Refection , need auth . Now what should i do should i adj the code with CO-45 or any suggestion? please advise. IF someone has denied code list or how to posting a payment through EOB?
 
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1) Was prior authorization requested & approved? If so, the denial may be in error. Call the insurer with the auth number and request that they reprocess the claim.

2) If a prior authorization was not requested, you may be able to request retro-authorization & if approve get paid for the service. (Some payors allow retro-auths. Some payors say if you didn't get authorization in advance too bad, so sad.)

3) If there's no authorization and you can't get authorization, then you'll need to write off the charge for that denied service.


I'm not clear on what you're asking about the EOB. Your office probably has policies/procedures for how to handle services denied for no authorization.

Most places I've worked would leave the balance on the account - they'd want us to at least attempt to get authorization from the payor, so we could be paid for the service. They didn't like to write things off until we were sure it was not payable.

But, your office may handle it differently. You'll have to ask what your policy/procedure is.
 
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