Workers’ Compensation benefits exhauste d No Returned Phone Calls utilization review letter of denial pre certification claim settled letter of medical necessity ODG exc “lNus”i oLInSsT no-fault NPI collections follow-up calls verifications chasing payments Serv adjustersPBMs extent of injury DUR prior authorization date of loss PAPERWORK Entitlement To Benefits peer review denied voice mail wrong form noncompensable no FTEs CASE MANAGERS phone messages Litigated timely filing National Carriers self-insured employers PIP need additional info out of network TPAs copay claim closed wrong carrier SHORTPAY DOI DISPUTED invoice correction fee schedule adjustment Dr. Not Authorized refill too soon invalid ndc DOB not covered reconsideration script reversed bill review bill not received staff time ingredients specific requirements follow-up overtime additional staff needed MORE FOLLOW-UP NEEDED hold time EOB EOR medical necessity jurisdiction regulations IME time-consuming repricing adjudication ODG requirements appeals verbal approval statutes injury report exceptions diagnosis non-matched ndc Simplified. All Payors, One BIN. Proven and Profitable.
20Ways Fall 2014 Issue: Community - Specialty - LTC
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