Forum - Questions & Answers

Jun 22nd, 2013 - azbillingnewbie

authorization for one procedure but another was performed what now?

We obtained a prior authorization for a 95810 & 95805 from insurance. The issue is that the patient had a 95811 and didn't need the 95805. The claim was billed as a 95811 and was denied by the insurance company. Is it possible to rebill the claim as a corrected claim as 95810 in order to get paid?

Jul 1st, 2013 - dsteed   141 

re: authorization for one procedure but another was performed what now?

When a different procedure is performed than the procedure authorized, you will need to immediately notify the payer and obtain a new authorization #. Was this done? If not, this is the reason your claim was denied. It would not be appropriate to bill a service not performed simply to obtain payment for billing service not authorized.



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