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Retro as opposed to Prior Auth is when the provider will have to go back after a service has been provided and try to get the authorization granted so the provider is paid. It’s unusual for this to occur. In rare cases, the patient coverage is unavailable prior to an encounter. This scenario most often occurs in emergency situations, due to an accident that develops during the night or on weekends. When this happens, the servicing provider must contact the payer as soon as possible and secure the necessary authorizations. The insurance carriers typically notify the provider the services are authorized however they must go through ConservCare Inc.

Workers’ comp reimbursements are extremely complex. With ever-changing and unpublished state fee schedules, various formulas and fee-affecting rules, and numerous other wrinkles, calculating reimbursement is no simple task. Due to this complexity, most providers do not know the actual reimbursement amounts allowed by workers’ comp. Therefore, providers frequently charge ‘usual and customary’ amounts, which are often higher than the state fee schedule.

This is where ConservCare will step in to confirm the bills are submitted at the appropriate fee schedule reimbursing the provider and submitting the bills correctly to the carrier the first time. ConservCare will negotiate with the provider if not already in-network; ConservCare will assume responsibility for reimbursement to the provider. Working together we will see greater efficiency and reduce claim costs. Average savings 15-20%.