Powerhouse of All Complex and Time Consuming Prior Authorization

Prior Authorization

Powerhouse of All Complex and Time Consuming Prior Authorization

The prior authorization(PA) process itself is a complex and time-consuming process, which is no longer a secret. In fact, researchers are still working on resuming a stress-free faster authorization process. 

Supported by various prestigious organization and institution including American Pharmacists Association (APA), Medical Group Management Association (MGMA), American Hospital Association (AHA) and American Medical Association (AMA) along with provider’s organization and payers like American’s Health Insurance Plans (AHIP) Blue Cross Blue Shield Association (BCBSA) and many others formed few statements easing the complex authorization problems that are:

  • Applying selective Prior authorization requirement by distinguishing the prior authorization application categories. The distinction can be based on the provider’s performance, best medical practices, or any sort of contractual obligation to make the process easy.
  • A regular check and updating of prior authorization regulation are needed for reviewing the treatments that are subjected to prior authorization. This will help to remove invalid prior authorization treatment.
  • As communication is the key to all prior authorization. Effective and constant communication among providers, patients and insurers should be maintained for a faster authorization process. This will not only reduce potential authorization delay but also have proper operational transparency about the workflow.
  • A continuity patients treatment process should be followed and given importance when the patients s already undergoing the treatment.
  • Usage of updated electronic prior authorization portal giving transparency workflow and updated report should be accepted and encouraged making the process much faster and effective.

Though the above suggestion can reduce the complicated stress full authorization process, yet it requires an operational extension that can faster and effectively solving all the complex authorization problems. This is why PriorAuth Online powered by Sunknowledge Services Inc is the one-stop prior authorization destination for more than 28 specialties. 

Why PriorAuh Online?

With in-depth understanding of claims adjudication mandates of the payers for resolving authorization, PriorAuth Online is a web-based platform for all authorization initiation; approval and follow-up. Ensuring a 100% prior authorization submission on the same day, PriorAuth Online ensure 1000 claims in a single month. 

Mastering the authorization process, PriorAuth Online ensures 99.9% accuracy rate during the process which is the wish list of every prior authorization requirement.   

Steps our PriorAuth Online follow for successful prior authorization process: 

Collection of complete data- 

  • Name, date of birth, insurance details of Patient/subscriber
  • Servicing provider information details (LAB)
  • Ordering provider information details
  • Place of Service
  • Procedure / CPT codes
  • Diagnosis codes
  • The estimated date range for Pre-authorization 
Contacting the payer and working out payer related activity
  • Determine the process for prior authorization request submission, i.e. portal, fax, phone, etc.
  • Contact for UM/Pre-Authorization department
  • Fax to send medical notes
  • Expected turn-around time
  • Limitations/exceptions (if any) 
Initiation and follow up activities
  • Check to determine whether the patient is eligible based on payers requirement for PA
  • Initiate prior authorization as per payers’ guideline/protocol
  • Follow-up with the payer to check authorization status via outbound calls, portal etc
  • Follow-up with ordering physicians’ offices for medical notes, documents and therapy chart if required
  • Providing additional documents/information if requested by the payer 
Updating the Authorization outcome in the PM/billing system
  • Authorization
  • Date range
  • Units
PriorAuth Online advantages: 
  • Complete operational transparency with no extra hidden charges
  • 80% reduction in your operational cost
  • 30% shrink in your account receivable bucket from the 1st month itself
  • No-cost dedicated account manager with robust reporting
  • 100 satisfied clients with excellent industries references
  • $1 million Hiscox/Geico Insurance coverage for any errors of Omission & commission
  • We bear all costs of transition during your migration from the old vendor
  • No binding contracts 

Apart from excelling in diverse specialties prior authorization process, we also excel in providing a complete medical billing service including:

  • Order entry (patients, providers, insurance, item etc)
  • Eligibility verification (both online, calling)
  • Prior authorization with patients calling and doctor’s office follow up for relevant documentation that needed for the process
  • Re-authorization
  • Order Confirmation
  • Scheduling of delivery
Post billing services: 
    • Claims management
    • Rejection management
    • Payment posting auto (with and without audit as well as manual)
    • Account receivable follow-up
    • Account receivable and denial management 

So leverage PriorAuth Online benefit and be part of the highest productivity metric with a service charge as low as $7 per hour. For more information, get in touch with the PriorAuth Online expert over a ‘no commitment call’.

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