Prior-Authorization is a health plan cost-control process that requires physicians and other health care professionals to obtain advance approval from a health plan before a specific service is delivered to the patient to qualify for payment coverage.
We offer an exclusive low-cost Eligibility and Pre-authorization service, it is an automated, streamlined process for prior authorization that will reduce the administrative burden.
Pay only $500 a month for our Unlimited Eligibility and Pre-authorization program and cut your costs an average of 75% to confirm the insurance benefit of a patient!
Different health plans have different rules in terms of when prior authorization is required. But if prior authorization is required and is not obtained, the health plan can reject the claim—even if the procedure was medically necessary and would otherwise have been covered.
In some scenarios you must obtain approval from a patient’s health plan before moving ahead with a particular treatment, procedure, or medication.
In general, the more expensive the procedure, the more likely a health plan is to require prior authorization, but we recommend prior authorization on all procedures and lab orders.
We can run your patient eligibility and authorizations at a very low cost. We will give your staff hours back in their day by giving you reliable live patient eligibility verification every morning. Before you open your office.
Your staff will get every morning a spreadsheet showing them patient responsibilities Copay, amount of deductible met. If the patient needs an authorization. all the information your staff would need on a simple to read live spreadsheet.
We will provide a secure portal for document exchange which includes patient information and completed authorization/Verification data, plus you get a daily eligibility report every morning.
We will reconfirm the insurance benefit of the patient if you intend to make a determination of financial responsibility for the patient at the time when medical services are rendered.