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UCare denials - authorization

Heather L. Heim 4 years ago in Payments/ERA Modules • updated 4 years ago • 2

Good morning!  Curious to know if other facilities have recently seen UCare denying claims with the CO-197 denial code (authorization) for claims you sent that had the authorization number attached and the auth was valid?  The two facilities I bill for, I've seen this happen with several clients on the past couple of remits, so trying to gauge if this might be a more global issue with them right now.

Jen 4 years ago

Hello,

We have had some claims that deny for no authorization.  We call the provider help desk and often told that their system did not update the on their end to show the additional units that were added from the extension request approved.  Depending on who you talk to, some representatives will send the claim back others will instruct us to send resend the claim. 

Heather L. Heim 4 years ago

Thanks for the reply Jen.  I was thinking that might be the case.  The clients I'm noticing this on are all clients I've recently obtained new auths for.  It's almost easier to save the call and just resubmit the claims.

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