Clarification on claims with Prior Authorizations reprocessing

August 23, 2011

Our August 12 list serve/RSS feed should have stated that claims will now be re-processed to pay the lower of the billed amount or the Prior Authorization (PA) maximum allowed amount.

For example, a claim was billed for $80.00 but the PA had a maximum allowed amount of $100.00. The claim previously paid $100.00. Now, the claim will be reprocessed to pay $80.00.