PRIOR AUTHORISATION
According to the American Medical Association, Prior authorization (PA) is any process by which physicians and other healthcare providers must obtain advance approval from a health plan before a specific procedure, service, device, supply, or medication is delivered to the patient to qualify for payment coverage. Other terms used by health plans for this process include “pre-authorization,” “precertification,” “prior approval,” “prior notification,” “prospective review,” and “prior review.”
Many medical treatments need approval or pre-certification to be covered by the insurance company. However, the lack of standards for the information required and EDI standards for data exchange make the pre-certification process tedious and time-consuming, requiring experts with payer-specific knowledge to support clinicians in the delivery of care.
Benefits Of Prior Authorization
- Obtain timely authorizations from payers for procedures and services requiring prior approvals
- Adhere to payer-specific guidelines and processes for the submission of required information for each procedure
- Track each case through our workflow process
- Receive robust reporting on completed pre-certs and/or status updates
- Improve process standardization and develop business rules for specific cases
- Reduce prior authorization denials and obtain maximum reimbursements
- Focus on delivering high-quality patient care
- Reduce Operational Costs by 30-40%
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