When a surgery center receives an order/scheduling request for a future surgery, a copy of the order will be transmitted to UHS who will obtain approval for the scheduled service. UHS will receive a written authorization from the adjuster, confirming the pending surgery is accepted treatment of the injured body part, and it will be covered under the open claim. UHS will verify the surgery’s center participation in any applicable networks and request out-of-network authorizations as needed.
UHS will expedite its processes to secure authorization for STAT procedures as quickly as possible. UHS will continually update the surgery center on pending surgery requests.
When authorization is obtained, UHS will immediately notify the surgery center and provide documentation of the adjuster’s authorization.
After the operative report has been coded and charges entered, the surgery center will electronically transmit the charge file to UHS. UHS will obtain operative reports, intra-operative reports, implant vendor invoices, IBs and any other documentation needed to support billed charges. UHS will generate the UB/HCFA and submit it, along with all clinical and cost documentation, to the correct payer address.
UHS will contact payers shortly after bills have been submitted to confirm the invoices are being processed for payment. UHS will quickly resolve any deficiencies noted by the payer. When payment is received, UHS will review EOB payments against state workers’ compensation fee schedules and any applicable PPO contracts. UHS will submit reconsiderations on all bills that are not paid correctly and will continue collection processes until full payment is received.