Commandment 8
Thou shalt know thy line items – apply thyself to understand the process of line item approvals.
If you do not want to be constantly frustrated by rejections you must quickly learn which line items will get rejected by reviewers or will require adjuster approval. When working with third party administrators (TPAs) you will have to work through layers of review and approvals based upon insurance carrier guidelines. If you have a scope of work that falls outside of the norm you will need to communicate with the adjuster to discuss how they would like that scope of work broken down. A scope and line items that may not pass through the normal review process can be overridden if there is ample explanation through F9 notes, photos and the designation that this has been “approved by adjuster”. An important suggestion to facilitate the estimating process when writing up reports is to save and label estimates with key scopes that have been approved so that you can cut and paste from them in the future.
We all have our options of TPAs or program work. They are will force you to be a better story teller and force you to capture better documentation. Remember the one with the biggest file wins. Make your file thick!!!
Comments