Practice Quiz

Managed Care Nursing

Category - Healthcare Management

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A provider has received a denial for a procedure from the insurance company. The provider is concerned that this denial will put the patient at additional or imminent risk or harm.
  1. Ask the patient to pay out-of-pocket and submit a reimbursement later.
  2. Submit an expedited appeal to UM with additional clinical information.
  3. Submit an appeal to utilization management without additional clinical information.
  4. Submit a TAR to utilization management.
  5. None of the above
Explanation
Answer: B - The provider’s recourse after a denial for a procedure is to submit an expedited appeal with additional clinical information.
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