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When changes are made to the service plan, what's the Impact to the Provider?

  • The initial service plan the provider received would be ended and a new service plan created
  • There may be a decrease, increase, service eliminated, added service or some other change to service delivery
  • The provider may be unaware of the changes and continue to deliver services at the previous level
  • This could result in denied claims or billing that will need to be voided or adjusted
  • Providers may not be aware of changes.  Provider will need the current SA and the new SA.
  • If a provider does not have a service authorization with a PA number, claims may deny. Claims may also continue to be paid out of the PA number that hasn’t ended which would result in providers having to void claims.
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