WebSoftOSHow it works
The request carries the patient’s policy details, diagnosis, planned procedure and estimated cost. The approval is attached to the admission and the final bill is compared with it.
A final bill above the approved amount without an enhancement is a common reason for a claim being queried.
Frequently asked questions
What if the bill exceeds the pre-auth amount?
Request an enhancement from the insurer or TPA before the final bill, otherwise the excess may be queried or disallowed.
Related termsTPA