A lab test was performed for a genetic screening of prostate cancer. The plan would have paid $2,233, but after reviewing records, Nokomis denied this because the plan had a policy on when that’s appropriate to use, and the patient did not meet the criteria. We ultimately saved the plan the entire $2,233.
Oftentimes, you really need to review records to know for sure what occurred. Even though a plan has edits to catch uncovered services, we can help to really critically review each claim and efficiently review records.