If a claim denies for no authorization, check the patients case in QEMR to see if an authorization is either in the Attachments or if there is an authorization under the Authorizations tab.


Do Not submit any new claims.


If no authorization is found, contact the client to be sure that the do not have an authorization for this patient.  If not, please ask them to obtain and to let you know when they have it.  If the practice cannot obtain authorization, then you will need approval to write off this claim.


Always note the account in EZC of any communication in regards to the authorization issue. 


When and if approved, adjust the claim with an OA-999. This adjustment code is to only be used if the entire claim denies.  If the insurance paid part of the claim but not the other, then adjust off using either CO-15, CO-197 or CO-198 if these are the codes that were used on the remit. Otherwise, use an OA instead of CO.