When is pre-authorization required, and how does Resolute capture this on the claim?

Master the EPIC Resolute Hospital Billing Test. Prepare with detailed flashcards and multiple-choice questions, each with helpful hints and comprehensive explanations. Ace your exam!

Multiple Choice

When is pre-authorization required, and how does Resolute capture this on the claim?

Pre-authorization is required only for services that the payer designates as needing prior approval, not for every service. In Resolute, when such approval is obtained, the authorized number is captured on the claim so the payer can validate that the service had been approved before payment. This placement on the claim helps ensure correct coverage and reduces the likelihood of denials. It’s not about doing it after the service is finished, and it’s not universal to elective services only or tied to a separate system—the authorization number must appear on the claim to show approval.

Pre-authorization is required only for services that the payer designates as needing prior approval, not for every service. In Resolute, when such approval is obtained, the authorized number is captured on the claim so the payer can validate that the service had been approved before payment. This placement on the claim helps ensure correct coverage and reduces the likelihood of denials. It’s not about doing it after the service is finished, and it’s not universal to elective services only or tied to a separate system—the authorization number must appear on the claim to show approval.

More practice questions