We can assist providers by handling the administrative, communication, and tracking tasks involved in obtaining timely authorizations. We ensure that treatments, procedures, and medications meet payer requirements for coverage, thereby reducing claim denials and out-of-pocket costs for patients.
Determine which services, such as specific procedures, treatments, or specialty medications, require prior authorization from insurance payers. Complete and submit prior authorization requests with the appropriate forms and necessary details, including diagnosis codes, procedure codes, and supporting clinical documentation. Track each authorization request, following up with payers for pending requests to prevent delays in care.
Determine the reason for any authorization denial and provide feedback to providers as needed. Collect additional documentation to support appeals, such as more detailed clinical notes or alternate diagnostic codes. Monitor appeals through resolution, ensuring timely follow-up with payers to secure coverage approval when possible.