Claims and Appeal Procedures -- pre-service claim

[Guest JD698]

Can a pre-service claim be denied for failure to obtain precertification if it is required or is the remedy for this failure imposing a penalty?

[JanetM]

Depends on the plan. What does it say about failure to precert procedure?

Most common is impose a penalty for failure to follow pre-service requirements. Have not actually seen plan that flat out denys the claim for failure to precert.