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durable medical equpment

BMI Audit Finding of the Month: Audit Finds Prior Authorization Not Provided Prior to Claims Payment

Audit Issue:
The audited health plan required prior authorization for Durable Medical Equipment (DME) charges exceeding a stated amount.

Audit Finding:
We used AUDiT iQ to select sample DME claims for on-site review.  While on-site at the Administrator’s payment location, we confirmed that prior authorization was not provided prior to …

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