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NEWS & RESOURCES

Case Study

What Happens When An Unqualified Clinician Denies Your Hospital’s Claims?

Today, hospitals hear over and over that medical necessity criteria was not met when a payer denies a valid claim. However, in some instances, the reviewer responsible for making the call may not have the necessary clinical experience or training to evaluate the validity of a claim.

 

In this case study, Advicare describes how it used in-house clinical experts and long-standing relationships with the payer’s senior decision makers to ultimately overturn its client’s denied claims and recover six-figures of otherwise lost revenue.