Referring Physicians Lead to Medicaid Denials

When pathologists receive slides for review, they aren’t concerning themselves with the credentialing status of the referring physician.  Instead, they have one objective: Provide an accurate diagnosis for the work ordered.  Unfortunately, payors often concern themselves with such trivial concerns.  A great example of this is the recent practice of California and Indiana State Medicaid Programs rejecting claims because they cannot identify the referring physician.  The referring physician does not need to be enrolled as a Medicaid provider, but their information must be listed in their database.  APS has recognized this erroneous denial and resolves these claims as they occur.  We will continue to keep an eye on these and other State Medicaid programs, as use of this denial expands.  Rest assured that compensation for even the lowest paying work, such as Medicaid, is fought for on behalf of all clients.  APS will be sure to update you as denial trends continue.