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.”
Improve time to access to care for your patients.
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.
Benefits Of Prior Authorization
- Get timely authorizations from payers for procedures and services requiring prior approvals
- Adhere to payer specific guidelines and processes for submission of information required for each procedure
- Track each case through our workflow process
- Get robust reporting on completed pre-certs and/or status updates
- Improve process standardization and develop business rules for specific cases
- Reduced prior authorization denials and get maximum reimbursements
- Focus on delivering high quality patient care
- Reduce Operational Costs by 30-40%