Questions: Which is an example of a clinical denial for the provider's office? The type of bill is inconsistent with the place of service Diagnosis is inconsistent with the procedure The authorization number is missing or invalid The time limit for filing has expired

Which is an example of a clinical denial for the provider's office?
The type of bill is inconsistent with the place of service
Diagnosis is inconsistent with the procedure
The authorization number is missing or invalid
The time limit for filing has expired
Transcript text: Which is an example of a clinical denial for the provider's office? The type of bill is inconsistent with the place of service Diagnosis is inconsistent with the procedure The authorization number is missing or invalid The time limit for filing has expired
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Solution

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The answer is the third one: The authorization number is missing or invalid.

Explanation for each option:

  1. The type of bill is inconsistent with the place of service: This is more of a billing error rather than a clinical denial. It relates to administrative issues in how the service is billed rather than the clinical aspects of the service provided.

  2. Diagnosis is inconsistent with the procedure: This could be considered a clinical denial, as it involves a mismatch between the diagnosis and the procedure performed, which can lead to a denial based on medical necessity or appropriateness.

  3. The authorization number is missing or invalid: This is a common reason for clinical denial. Many insurance plans require prior authorization for certain procedures or services, and if the authorization number is missing or invalid, the claim can be denied.

  4. The time limit for filing has expired: This is a denial based on administrative timing rather than clinical reasons. It occurs when a claim is submitted after the deadline set by the payer.

In summary, the most direct example of a clinical denial from the options provided is when the authorization number is missing or invalid, as it directly relates to the clinical approval process required by insurers.

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