Prior Authorization
Helping patients get access to the medications
Prior Authorization
Another greatest contributor to lost revenue is the failure to obtain a referral or authorization before performing a procedure as the most common denial in medical billing reimbursement rates as Pre-Authorization, Prior Authorization, Pre-Certification, and Notification. Not all services and procedures require a referral or pre-authorization, but if a referral or pre-authorization is required and is not obtained, reimbursement for the procedure is put at risk.
Authorization is the process of getting a medical service(s) authorized from the insurance carrier. Providers or Medical billing companies have to contact insurers in advance and obtain a certification number in order to be reimbursed properly. These processes result in an authorization and referral number and provider’s/billing companies must use on claims submitted for payment.
SouthWest Billing is well aware of the Authorization and Referral process. We consider and manage it as a special project in Medical Billing Cycle because of the time and costs associated with it. Our Authorization Specialists have wide-range knowledge of functionalities and compliance with payer contractual requirements. We identify, verifying eligibility, obtaining insurance benefits, and ensuring pre-certification, authorization, and referral requirements through in all paperwork and research relevant to each case from the payers. We Obtained prior authorizations and referrals from various payers by submitting clinical information via fax and online payers web portals or by speaking directly to a case management representative. We ensure end to end, timely, and accurate submission of prior and retro authorization and referral requests to the payers. it is our pledge to make everyone aware of any changes or implementations that may potentially impact your financial growth.
SouthWest Billing referral and pre-authorization services ensure that the patient is approved for the planned service or procedure before arrival, ensuring that the first stage of the revenue cycle is completed accurately. This sets the rest of the claims process up for success.
Our authorization and referral management systems give your team the tools they need to verify insurance eligibility and make sure the correct patient authorizations and referrals are in place so they can get paid.