May 2013

Medicaid reimbursement denied due to untimely preauthorization code change.

Petitioner, a hospital, appeals Respondent’s decision to deny its claim for Medicaid coverage of an inpatient medical procedure it performed on a patient in its facility. The patient had originally been scheduled for an outpatient procedure and the procedure had been coded as such. Petitioner failed to request an update in the precertification code within

Medicaid reimbursement denied due to untimely preauthorization code change. Read More

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