DESCRIPTION OF THE ISSUE
The claims of Wellcare
were initially denied for “No Authorization on file”. {submitted with the
Tax-Id# 123456789}.
CONCEPT
If a provider is
capitated under a plan, we need to verify on all the information of the
provider with the concerned Insurance records to avoid denials of
missing/incorrect provider’s information.
SOLUTION
Upon verification with
Wellcare we found Dr. had separate Tax-Id# 987654321 and was capitated
with this plan. Hence all the claims were refiled and processed under
capitation
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