Page 7 - C.Journal 3rd edition

Claims Journal 3rd Edition Claims Journal 3rd Edition

Common

QC Mistakes

Approving services although not part of PA request Approving services although not part of PA request
Scenario: Scenario:
A patient attending for dental clinic having PA for filling only Preauthorized physiotherapy for 6 sessions.

Adjudicator Error Adjudication Tips Adjudicator Error Adjudication Tips

The sessions in the PA must
Approving consultation Any dental service not - Approving 7 sessions for the match the number of sessions
although it is not included in preauthorization patient although the approv- in the claim, but not exceeding
preauthorized. should be rejected by al for 6 only. them.
shortfall 79. We should check the date of PA
- Attaching wrong PA number. prior the sessions in the claim
As in the claim there is unused
PA in 27-Oct which is probably
attached to this claim.

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