Reminder: Be sure to send chart notes with prior authorization requests

As reported in the August Record, many claims are rejected because a claim submission contains incomplete documentation. Once the missing information is submitted, the claim is often approved, avoiding a member appeal.

One common example of incomplete or incorrect documentation is neglecting to include chart notes with prior authorization requests for a drug that is part of our prior authorization program. Chart notes help confirm the need for the drug, which supports the coverage requirements.

As always, verifying member benefits and eligibility, reporting your claims accurately, obtaining required prior authorizations and including chart notes with prior authorization requests will reduce the number claim rejections and resulting member appeals.