Improve Collections

According to the American Medical Association, Prior authorization (PA) is any process by which physicians and other health care 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.”

Quite a few of the medical treatments need to be approved or pre-certified to be covered by the insurance company. However, lack of standards for the information required and EDI standards for data exchange, makes the pre-certification process to be tedious and time -consuming, and requires experts with payer specific knowledge to support clinicians in the delivery of care.