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 Precertification Request Form for Non Participating Providers Aetna 2013

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Over the years we received a number of questions and calls regarding the Medicare fee schedule and trying to understand the differences in all the different numbers, and rEvally it boils down to three sets of numbers it's the allowable charge for participating providers it's the allowable charge for non-participating providers and the limiting charge everything is rEvally based on those three figures so the way the fee schedule works is it utilizes the allowable charge for a participating provider as the baseline so if that charge were to say were to be $100 then of course you would charge either $100 or your standard office fee which ever is a lesser amount and so if you're a participating provider that rEvally is easy in and for participating writers you can charge your normal office fee and Medicare will adjust that down to that allowable amount through the remittance advice process or through the EOB process but then where things get confusing a bit is when we move into that non-pa

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