What happens if block 13 is left blank when submitting claims?

When block 13 is left blank on a claim form, it generally indicates the absence of an authorization or a referral that may be required for services rendered. If a prior authorization is mandatory for the specific service or procedure to be reimbursed by the insurance company, failing to fill in this block could result in a situation where the insurance carrier denies the claim.

In this scenario, since the patient is the one who ultimately is responsible for ensuring that the necessary authorizations are in place with their insurance provider, they could be held financially liable for the cost of the services if the claim is denied due to the missing information in block 13. Thus, the patient may end up having to reimburse the provider for the services received, which is why this choice accurately reflects the consequences of leaving block 13 blank.

Furthermore, claims are not expedited or automatically approved without the required information. Incomplete claims typically lead to longer processing times as issues need to be resolved before payment can be made.