I have a question on a surgery denial. Prior to surgery i verified no preauth was required and got a call reference#. Procedure was outpatient so no alarm bells went off. Surgery was performed and billed. Surgery was denied for No preauth. I called and the claims rep was able to verify my previous call reference # and that I was given incorrect information. Recommended an appeal. I also called the medical mgmt dept and tried to get retoroauth. Medical mgmt dept at insurance reviewed and said initial rep did give me correct information and no auth was needed. Rep then was nice enough to do conference call with claims dept and told claims customer service claim should be processed. Got a reference # on that conference call. Despite that claims dept is still upholding the denial. Any recommendations? I understand if we didn’t try at all but in this case I really did. Of note provider is Oon w/ insurance. On the calls we did tell both medical mgmt reps pre and post sx the providers status and CPT code

Also pt does have secondary insurance which did give us an auth. Should I bill secondary or wait till " resolution with primary"? Primary EOB currently states no pr resp if contracted which we are not.

Thank you!