Have you ever considered how long a pre-authorisation reference is live? Or how many didn’t realise some private medical insurance companies deem pre-auths do have a life span?
For example:
I was asked to invoice for a surgical episode, which took place last week. The patient had the right pre-authorisation reference. The CCSD code was correct too. However, the pre-auth code was dated September 2022. This particular PMI decreed the code was only valid for 45 days. So what is the solution? Simple.
Pick the phone up
Call the insurance company and explain why the surgery took place so long after the issue of the pre-auth reference. It shouldn’t be a problem.
Funnily enough, another MHM client asked us to invoice against a pre-auth reference of a similar age to the above example. There was no issue in this second example also because the insurance company concerned in this case deem pre-auth to be “live” for six months.
Have you considered, however, why there was such a big delay between the issue of the pre-auth and the episode? Might be a perfectly reasonable explanation.
However, if the code was issued 6 months ago and the episode took place a week later, you will be asked questions as to why it’s taken so long to invoice. Some insurance companies will actually automatically decline if an invoice is submitted for payment six months after the episode.
Life span
See what I mean. Both pre-authorisation and invoices have a life of their own. Clinic and surgical episodes should be invoiced within seven days at the maximum.
How many of you are NOT meeting this deadline?