Thank you so much for this information! If others have processes they are willing to share I would greatly appreciate that too.

 

 

SO yes, this is not always easy depending on the cares the patient needs. We need to make sure the client gets their needs met but we usually say, no auth, no service. Sometimes, we will do 2-3 visits if the client is struggling to find other ways to get cares. For example, when they have inactive MA, we will have the nurse check with the client as to whether it is just a paperwork processing issue or something else. If its paperwork processing for their renewal, we will see them for 2-3 weeks at 1x/wk. If they do not have MA active after that, we discuss what we should do going forward. If it is an authorization issue, we do not see clients until we have authorization. On admit, sometimes it takes a bit to get authorization. So we make sure we have our authorization process in motion and that all paperwork is sent to the authorizing source after the first visit. Then we continue seeing clients  while waiting for auth. They key is to request auth BEFORE providing services. If we get a response from a payer saying they will not authorize a service, we will not see the person for that service. At that point we help the client come up with a  game plan to meet their needs in another form or we follow up with the payer to find out what we can do to get the service authorized.

 

 

 

Thank you for your responses. Triwest did not authorize ongoing auth. We had auth through Triwest through 12/26/19. I have two further questions:

1.       What is your company’s policy regarding authorization. If an insurance company is not authorizing ongoing do you hold services? Ethically this is something our facility really struggles with. And it seems like we all have different opinions on how this should be handled.

2.       On admit do you provide services that do not have authorization? We have to admit within 48 hours, but what if the authorization is still pending with the insurance company?

 

Thank you!

 

 

Are you saying VA would not authorize or that Triwest does not have auth in their system? If VA would not auth then you should not bill anything after 12.26.2019. 

 

 

If they did not authorize, we would not have provided the service. They should have authorized it. I think you are out of luck.

 

 

 

Good morning,

We have a patient that authorization through Triwest ended 12/26/19 and from 12/27/2019-1/13/2020 they would not authorize. Our rap is dated 12/30/19 and falls within the no auth range. They denied it for auth. I am assuming our final claim is going to deny for not having a rap processed. Have any of you run into this issue? Do you end up writing off the entire episode? Triwest and VA have both been terrible about processing our auth requests the date that they complete it, not the date they receive it. Just wanted some additional input or suggestions if anyone has any. Thank you!

 

April Hanson

Patient Accounts

Perham Living

Ph: 218.347.1894

F: 218.347.1885

April.Hanson@perhamhealth.org

Dedicated to health and wellness throughout life.

 

 

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