N45: Payment based on authorized amount
The payer paid according to a prior authorization amount rather than the billed charge. If the billed amount is higher than what was authorized, the difference was adjusted off.
Corrective actions
- 1
Compare authorization to billed services
Pull the original authorization and confirm the units, dates, and codes match what was billed; a mismatch is the usual cause of a reduced payment.
- 2
Request an authorization amendment if justified
If additional medically necessary units or services were provided beyond the authorization, contact the payer's utilization management department to request a retroactive amendment before appealing.
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DenialPath provides billing and administrative guidance based on published CMS and X12 sources. It is not medical advice, not a coverage determination, and not a guarantee of payment. NCCI and MUE edits are republished quarterly and payer policies vary by contract. Always confirm against the payer's own current policy before submitting or appealing.