Authorization Denial in Medical Billing
Authorization denial occurs when an insurance company refuses to approve a service, treatment, or procedure, typically due to medical necessity or lack of pre-authorization.
Authorization Denial in Medical Billing Explained
Authorization denials often happen when prior approval is not obtained for a service or when the payer determines that the service is not medically necessary under the terms of the patient’s insurance policy. Resolving authorization denials typically requires an appeal or submission of additional documentation.
For example, a healthcare provider receives an authorization denial for a surgery that was performed without prior approval, leading to a claim denial.
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