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When not managed properly, prior authorizations and referrals can be a huge administrative burden.
Our Authorization & Referral Management Services, which includes proactive prior authorization management, assist practices in monitoring payer needs and in keeping organized records through the medical authorization management process.
Our proactive monitoring of authorization and referral needs helps to minimize administrative delays and prevent unnecessary claim problems.
Our prior authorization management services ensure that the requirements are met prior to the patient encounter, monitor pending prior authorizations, and perform direct follow-up with payers to guarantee approvals don’t get lost in the cracks.
From initial verification to final approval, here’s how we ensure every authorization and requirement are tracked and managed.
Prior authorization is confirmed with the payer before the patients visit.
Prompt referral and authorization requests are made using payer portal, phone, or fax.
All authorisations and expiration dates are monitored and do not expire or go missing.
As part of our authorization and referral management process, urgent or delayed authorizations are elevated immediately to the payer.
Get answers to the most frequent questions that healthcare providers have about our medical billing, coding and revenue cycle management services.
Before the patient comes to us, our staff checks authorization requirements with the payer, which is done based on the plan, procedure and diagnosis, before the claim is submitted.
The speed of turnaround depends on the service performed and the payer, but it’s generally within a few business days; our team will reach out proactively to prevent delays.
Typically the patient’s insurance details, diagnosis and procedure codes, provider information, and supporting clinical documentation are required to submit an authorization request..
Yes, authorized requests for immediate authorization are monitored and escalated to the payor to help reduce delays to patient care.
All authorizations are documented and followed up on on a regular basis until resolved or approved, and include the status, expiration date, and visit/unit limits on each authorization.
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