precertification

What is The Difference Between a Pre-Authorization and a Post-Authorization

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A pre-authorization, also known as prior authorization, precertification, or prior approval, is used by insurance carriers to determine if the services being requested by your office are medically necessary for patients. Typically, a prior authorization request is sent before a service or procedure is provided to ensure proper payment when submitting a claim. However, submitting …

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What is a Prior Authorization and Why is it Important

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What is precertification, prior authorization, or pre-approval? Today, many procedures and diagnostic tests, regardless of provider specialty, require prior authorization, but what exactly is it, and why do you need it? A prior authorization request provides information to the insurance carrier, who then will provide written confirmation that the procedure or diagnostic test can be …

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Top 15 Services Requiring Prior Authorization for Cardiologists, Interventional Cardiologists, and Vascular Surgeons

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Cardiologists face some of the most stringent pre authorization requirements of all the medical specialties. From routine echocardiography to complicated surgical procedures, insurance carriers are demanding an increasing layer of oversight over patient care through the prior authorization process. As a rule of thumb, for Cardiologists, Interventional Cardiologists, and Vascular Surgeons, the following fifteen categories …

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Prior Authorizations for Cardiologists: Everything You Need to Know

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Cardiology practices face some of the biggest burdens when it comes to obtaining prior authorizations for necessary diagnostics and procedures. Today, everything from Echocardiograms, Dopplers, and Ultrasounds, to procedures like Cardiac Catheterizations and Stents require prior authorization. Interventional Cardiologists face an even higher burden when it comes to precertification requirements, often requiring patients to return …

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How to Create a Precertification Request

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Prior authorization requirements for diagnostics and procedures are evaluated on a case-by-case basis. There are no streamlined requirements for prior authorization among the various insurance carriers, and each case must be processed individually. For carriers requiring prior authorization, it may be obtained by phone, web portal, or other submission methods depending on carrier requirements. In any of …

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