Wiki Appeal for wrong place of service auth that PCP obtained

[chelsak83@yahoo.com]

I work for an ASC and the PCP obtained an authrozation for a different Surgery center( which we did not know about ). We did the surgery submitted charges with auth number the PCP provided, and we were denied due to no prior auth obtained for our surgery center. pcp tried to change it to our facility but ins company will not change and told PCP, we will have to appeal it as the ASC. I can't figure out how to fight this.

Thank you kindly,
Chelsa T. CPC, CPB

 

[LCR CPC]

If your facility is contracted with the payer, you might try calling the prior auth department to see if they'd be willing to change the auth, but after the surgery has been performed, its a long shot. Your network rep might be willing to help on a "one time only" basis. If you aren't contracted, you might try appealing indicating that you'll accept the contractual allowance the other ASC would have received. Without knowing if there were "extenuating circumstances," your ASC was simply not authorized to perform the surgery. Does your facility separately verify the auths with the payer? It sounds like this one slipped through the cracks.

 

[chelsak83@yahoo.com]

I did call Ins, and they said they are gonna change it for me if I send them the op report showing that the patient surgery was performed here. Surprised and crossing fingers. Thank you for writing back.