Prioritizing Patient Care through Effective Prior Authorization Management
Ensuring coverage for a wide range of medical procedures: Prior Authorization for radiation therapy, DME, injections, surgeries, and more for workers’ compensation, no-fault, and private insurance.
Prior Authorization
A pre-certification requirement is sometimes required by Medicare, point-of-service plans, and managed care plans for outpatient procedures, surgery, and hospital admissions. If prior authorization is not obtained, the provider may suffer huge financial losses.
To assist physicians with credentialing services in the USA, outpatient facilities, and hospitals in the following ways, we offer prior authorization services
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Our Prior Authorization Services Pave the Way for Streamlined and Efficient Medical Care Approvals
Ensuring Proper Pre-Certification for Medical Procedures: A Guide to the Requirements and Best Practices
The pre-certification process is critical to ensuring seamless and efficient medical care. Our organization is committed to effectively managing the pre-certification process for all procedures. Our prior-authorization specialists will ensure that all necessary information is included in the pre-certification, including
- Properly submitted preauthorization-required treatments and services.
- Prior authorization requests that meet the payer's criteria.
- Detailed patient information, including insurance and demographics.
- A physician order, either in writing or given verbally.
- Referral to specialists as necessary, as directed by the primary care physician.
- A comprehensive explanation of the diagnosis, medical history, clinical indications, and reason for the exam.
- Expected number of sessions for stays in hospitals and extended care facilities.
- Properly coded treatments and diagnostic procedures based on ICD-10 and CPT codes.