One of our payors use a company to do their "chart review" for surgeries
We send our op reports to this company - and they determine if the documentation supports codes submitted and they tell the payor to pay/deny claim
My problem is they use a Urologist to review (and deny) my ortho surgeries....I have literally photocopied the dictionary with definitions & anatomy and have gotten the claim paid
Any secrets on how to require a reviewer to use Ortho MD on ortho claims ? my specialist has to be special.....their specialists are not special - this is a time waster !
thx
We send our op reports to this company - and they determine if the documentation supports codes submitted and they tell the payor to pay/deny claim
My problem is they use a Urologist to review (and deny) my ortho surgeries....I have literally photocopied the dictionary with definitions & anatomy and have gotten the claim paid
Any secrets on how to require a reviewer to use Ortho MD on ortho claims ? my specialist has to be special.....their specialists are not special - this is a time waster !
thx