Prior Authorization

Certain medical procedures require prior authorization, pre-certification, pre-notification, or pre-authorization from the insurance company before services are rendered to the patient. As a health service provider, you need to ascertain whether a particular service requires pre-authorization before you put your patient through the procedure. This is an important process during the insurance verification process.

So what’s prior authorization, and why is it required in certain services?

Most health insurance providers specify the services that require pre-authorization in advance through their Medical Benefits Chart. Prior authorization is a process by which a health coverage plan is verified to determine the level of coverage or ascertain if the proposed medical treatment or procedure is covered under the client’s plan. The insurance provider can either authorize or decline to cover the procedure based on their plan terms and conditions.
When you fail to obtain prior authorization, you may end up providing certain services to the patient without receiving any pay. In other words, the absence of authorization may lead to claim denials or non-reimbursement. As a medical service provider, once you receive pre-authorization from a payer, you’ll be given a pre-authorization number. It is this number that you will use in claims to avoid dishonest denials.

Services that require pre-authorization

Although every insurance provider has a specific set of requirements, most risky and expensive services require prior authorization before you begin the treatment or procedure on your patient. For example, most preferred provider organizations (PPOs) have set up specific conditions in their plans that require that a medical service provider seek pre-certification from the insurance providers for inpatient hospital admissions, coordinated healthcare, MRI/MRAs, CT/CTA scans and other procedures.
With proper verification and prior authorization from Human Resources For Me’s team, you will ensure the growth of the revenue of your practice. The comprehensive suite of insurance verification and authorization services helps enhance practice revenue and ensure that services provided do not go unpaid. Providers in every specialty would especially benefit from these services.

How Human Resources For Me will help you out

  • Speed: We act swiftly when it comes to seeking pre-authorization from insurance providers because we are aware that some treatments or procedures may need such a quick response.
  • Keen on details: We inquire about every aspect of your patient’s coverage.
  • Reliable: We give you reliable pre-authorization services to allow you more time to attend to your patients. Our process will massively reduce the risks of denial and save you valuable time.

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