Authorization and Eligibility
Your first line of defense against payment denials
Our team of authorization and eligibility verification experts are trained in preventing claim denials due to a lack of insurance coverage or prior authorization. Obtaining pre-authorizations can be a time-consuming and confusing process due to the complexity of different insurance guidelines and continuous updates. Our team ensures that all payor criteria are met before submitting an authorization request and offers a streamlined approach to obtaining precertification approvals.
Our Prior Authorization Process Includes:
- Confirming patient insurance coverage and eligibility verification (from detailed coverage information to secondary and tertiary insurance information)
- Confirming provider plan participation
- Determining if pre-authorization is required for any expected diagnostic or procedure
- Obtaining all necessary documentation for prior-authorization approval
- Submitting supporting medical necessity documentation or information, as requested by the insurance carrier
- Coordination of peer-to-peer reviews, as needed
- Submissions of appeals and followthrough to final carrier decision
- Retroactive authorizations for urgent cases or last-minute procedure changes
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