If the hospital's prior authorization request is "non-affirmed", then all associated claims will be denied.
33. Q: The Rule states that any claims associated with or related to a service that
requires prior authorization for which a claim denial is issued would also be denied.
What types of associated services will be denied?
A: Associated/related (professional) services will be denied when there was a nonaffirmation prior authorization request decision for the hospital OPD service(s), regardless
of whether a claim is submitted or not, or there was no prior authorization request on file,
and the hospital OPD claim was denied. These associated services include, but are not
limited to, services such as anesthesiology services, physician services, and/or facility
services.
Donna Richmond, BA, RCC, CIRCC, CPC
Senior Healthcare Consultant
T 651-424-4225
C 337-412-2272
www.panaceainc.com
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