Precertification & Prior Authorizations
Insurance precertification and prior authorizations require skilled specialists to ensure all of the necessary processes are followed in accordance with plan requirements. Each request for additional information or precertification will need to be followed-up to ensure approval before the service is provided.
ProviderSense provides a blend of dedicated staff and automation to handle your prior authorizations correctly and timely. We complete all of the benefits verification work before your patients’ visit and follow up with the payers until we have obtained confirmation of insurance authorization approval or denial.
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Our Prior Authorization team will verify all Eligibility details for your patients such as:
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Plan Type, Policy or Insurance ID#, Group#
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Effective and Termination dates
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Eligibility Status
Authorization Process
Once we have verified a patient’s eligibility status, we determine which CPT codes require authorization and open a case with the payer’s insurance authorization department. We then securely send required supporting clinical documentation.
After obtaining the authorization, we send you the authorization number and update the information in your billing system or our portal.
If denied, we obtain additional records and other details from your office, and send them to the insurance company to be further reviewed.
If a payer requests a peer-to-peer review, we update your billing system and our portal, and communicate the necessary details to the practice to schedule the provider’s call with the payer.
The Advantages to Utilizing our Precertification & Prior Authorization Services include:
Expertise
Our precertification specialists stay current with all the precertification processes for Medicare, Medicare, and other payers. Our expertise allows your staff to focus on other tasks by not having to spend time in ongoing training.
Fewer Billing Issues
We provide the expertise and proper diligence necessary to track each medical prior authorization request from start to finish. This results in fewer precerts being left incomplete and fewer billing errors. We guarantee 24-48 hour follow-up on submission approval status.
Improved Patient Satisfaction
We help ensure patients have the necessary precerts before they come in for their appointment. This means less time spent tracking down forms or information and fewer appointments rescheduled because a precert hasn’t gone through.
Save Time & Money
Our services help you streamline your day-to-day operations, saving time and constant disruption. You also do not have to hire and train staff to handle tasks that can be handled less expensively utilizing our expert staff and automation.