Prior Authorization

Improve time to access to care for your patients.
Improve Collections.

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.”

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.

Revenue cycle management

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%