What happened between the payer check and the payment?

Your team checks the payer’s requirements and sees “no prior authorization required.” Then the claim comes back denied. What happened—and what should you check next?

Join Ernie de los Santos for a practical discussion of changing authorization requirements, the evidence that needs to follow the account, and the handoffs that deserve a closer look. We’ll work through two hypothetical cases and take your questions live.

What you’ll take away

• A clearer verification process: identify the patient’s plan, service, and applicable requirements before changing your workflow.
• A sharper payment review: separate the authorization requirement from coverage, medical necessity, and claim-payment questions.
• Better denial-review questions: examine how an actual Medicare Advantage approval affects review of a later denial.
• A stronger handoff: trace clinical documentation and the payer decision record through to billing.
• A Monday action plan: review one service group and identify one practical workflow improvement.

Two cases. Questions your team will recognize.

Bring your people who touch the account

For hospital patient access, case management, UR/UM, physician advisors, CDI, coding, billing, compliance, revenue cycle leaders, and denials and appeals teams.

Bring a de-identified account question or a workflow problem that keeps creating rework.