We recommend that the Plan revise its policies and procedures to ensure that it appropriately and timely prior-authorizes claims and that proof of medical necessity is fully validated when required by the Contract, regardless of the type of provider requesting the service.
Questioned Costs
$0
Funds for Better Use
$0
Recommendation Status
Closed
Source UUID
ce56b9f0-96fc-4b6c-959b-a3a969e994d9-4
Recommendation Number
4
Significant Recommendation
No