If a claim is denied by Medicaid because prior authorization was NOT obtained, the physician can bill the patient for the services.

Question

Quizplus · Accepted Answer

Medicaid program prohibits physicians from billing patients for services that were denied due to a lack of prior authorization. Physicians need to follow the prior authorization process to get reimbursement for their services. Billing patients for services that Medicaid denied is considered balance billing and is strictly prohibited by Medicaid regulations.

If a Claim Is Denied by Medicaid Because Prior Authorization