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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.
Atom Healthcare aims to transform healthcare business processes by applying global delivery, technology, automation, and seasoned professionals to help our customers achieve market leading outcomes.
