A particular health plan offers a higher level of benefits for services provided in-network than for out-of-network services. This health plan requires preauthorization for certain medical services. With regard to the steps that the health plan's claims enforcement policy, clients:

Question

A particular health plan offers a higher level of benefits for services provided in-network than for out-of-network services. This health plan requires preauthorization for certain medical services.  With regard to the steps that the health plan's claims enforcement policy, clients:

Quizplus · Accepted Answer

Clients should investigate any conflicts between diagnostic codes and treatment codes before approving the claim to ensure that the appropriate payment is made for the claim. This is important as the health plan offers a higher level of benefits for services provided in-network, and preauthorization is required for certain medical services. Therefore, clients need to ensure that they are approving the claim for in-network services that have been preauthorized and for which the appropriate payment is made.

A Particular Health Plan Offers a Higher Level of Benefits