DESCRIPTION OF THE ISSUE
The claims of Wellcare were initially denied for “No Authorization on file”. {submitted with the Tax-Id# 123456789}.
CONCEPT
If a provider is capitated under a plan, we need to verify on all the information of the provider with the concerned Insurance records to avoid denials of missing/incorrect provider’s information.
SOLUTION
Upon verification with Wellcare we found Dr. had separate Tax-Id# 987654321 and was capitated with this plan. Hence all the claims were refiled and processed under capitation
