If a claim is denied because additional information is needed to prove medical necessity, the medical office specialist should:

Question

Quizplus · Accepted Answer

The best choice is to submit the required information and follow up with the carrier to prove medical necessity. This ensures that the claim can be properly processed and paid without billing the patient or writing off the entire amount. Asking the patient to write a letter may not provide sufficient evidence to support the claim, so it is important to submit the required medical documentation directly to the carrier.

If a Claim Is Denied Because Additional Information Is Needed