What is the process for obtaining prior authorizations?
- Training staff members to know the CPT and ICD-10 codes
- Training staff members on medical necessity
- Completing requests online or through a paper/manual request to the Primary Care Physician
- Following up on requests in an organized manner to ensure approval has been received for ordered service
- Entering authorization numbers in appropriate areas to ensure billing has appropriate information to bill the claim.
- Overall, we have a success rate of 99.54% for over 10,000 prior authorizations submitted.
How our service is above and beyond
- Establishing excellent professional relationships with the surrounding primary care physicians
- Following medical necessity guideline to ensure efficient processing
- Efficiency with submitting requests for ordered services within an extraordinary timeframe (24 hours)
- Providing care calls to clients to document more detail in medical necessity
- In 2016, we had a success rate of 99.54% for over 10,000 prior authorizations submitted
The Authorizations Department in a specialty office is a core component of seeing clients in the office and booking for any type of procedures.
What Services Require Authorization?
- Office Visits
- Urine Drug Analysis
- Surgical Procedures
- Durable Medical Equipment
- Physical Therapy
- Imaging/Radiology
- Medications
Prior Authorization is defined as a process used by some health insurance companies in the United States to determine if they will cover a prescribed procedure, service, or medication.
Prior authorizations can take up to 14 days to obtain based on the insurance and service ordered, however, on average through our protocols and structure we are able to obtain authorizations in 1-4 days.
Ensuring that Authorizations are obtained in an efficient manner in order to offer superior care to the client.