If authorization is given for medical treatment, can payment be denied when bill received?
No. When authorization is given, services are provided in good faith, therefore, payment must be rendered. Reimbursement determinations shall be based on medical necessity of services to either establish a diagnosis or treat an injury/illness. Thus reimbursement shall not be dependent on the outcome of medically necessary diagnostic services or treatment.
Related Questions
- What recourse does a medical provider have if treatment is rendered in accordance with the Guidelines and does not receive payment or a response from the insurance carrier?
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