Before submitting prior authorization requests, it is important to check patient eligibility and insurance coverage. Our team makes sure that:

• The patient’s insurance policy is active and valid.
• The requested treatment, medication, or procedure is covered by the plan.
• The service follows payer-specific guidelines to reduce the chances of rejection.

By verifying insurance accurately, we avoid unnecessary delays and help create a smooth authorization process.

The success of a prior authorization request relies on the quality of the documents submitted. We manage this important step by:

• Collecting all necessary documents, like medical history, treatment plans, test results, and doctor recommendations.
• Checking the documents for accuracy and completeness.
• Preparing the request according to the payer’s specific requirements.

By making sure all information is accurate and organized, we lower the chances of denials and resubmissions.

Submitting prior authorization requests can take a lot of time. Each payer has different rules for submissions. We help you by:

• Prepare and submit requests electronically when possible.
• Manually submitting requests when electronic options are not available.
• Making sure all submissions have the needed documents, forms, and evidence.

This simple approach speeds up approvals and avoids extra problems.

Once you submit a request, the process continues. Regular follow-ups are important to get approvals on time. Our follow-up services include:

• Tracking the status of pending requests.
• Communicating with insurance payers about any issues or delays.
• Provide updates on your practice so you know about the progress.

By keeping in touch with payers, we reduce wait times and keep everything on track.

Even with our best efforts, some prior authorization requests may still get denied. This is where we excel:

• We look into the reasons for the denial, like missing information, coding mistakes, or payer policy problems.
• We fix errors, collect more documents, and resubmit the request.
• If needed, we file appeals to reverse denials and get approvals quickly.

Our proactive approach to managing denials helps reduce disruptions to patient care and ensures timely reimbursements.

For patients needing long-term or chronic treatments, prior authorizations must be renewed regularly. We manage this process by:

• Tracking expiration dates for current authorizations.
• Starting renewal requests early to avoid care gaps.
• Meeting specific payer requirements for renewals carefully.

By managing renewals ahead of time, we ensure smooth and continuous care for your patients.