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All You Need to Know About Prior Authorization for Infusion Services

All You Need to Know About Prior Authorization for Infusion Services

The global home infusion services market size was valued at USD 22.2 billion in the year 2018, which is projected to expand at a CAGR of 7.2% from the year 2019 to 2026. This is because infusion services have received a lot of positive impacts according to the HME news in a recent survey, which was collected from 1,369 program participants, representing 6,958 patients who received infusion services between January and March 2019.

One more reason that causing the rise of infusion service, is the growing geriatric population base on the suffering from decreased mobility profile that boosts the demand for home infusion therapy. In fact, the U.S. Department of Health and Human Services has estimated an issue that says the population of aged 65 years and above was 46.2 million and will increase with the coming years; as the advent of smart pumps made the practice of infusion therapy easier in homecare settings.

 Survey has even reported infusion service patients being satisfied with their care, according to the first quarter results of the National Home Infusion Foundation’s Home Infusion Patient Satisfaction Benchmarking Program. The advantage infusion services offer is that it can deliver a specific dose of medicine quickly, and in a well-controlled manner throughout the body. As the infusion services manage chronic and complex conditions, like immune globulin therapy and therapies with the most utilization, are intravenous (IV) antibiotics prescribed for cellulitis, sepsis, osteomyelitis, urinary tract infections, pneumonia, and sinusitis; it needs a proper prior authorization process. Being used for irritating solutions that can even cause pain and damage tissues if given by subcutaneous or intramuscular injection further rises the need of prior authorization process for the infusion services.

PriorAuth Online: The Ideal Prior Authorization Solution for Infusion Services:

Understanding the value of the client’s time, money and the infusion service industry mandate and authorization rules and regulation, PriorAuth Online is the perfect prior authorization destination. Helping in delivering the right action plan that improves the authorization process and the cash flow in the long run; PriorAuth Online excel in delivers all the heavy lifting work.

Catering to all prior authorization requirements for infusion services, PriorAuth Online experts not only take the extra initiatives in working towards 100% prior authorization on the same day but also have the benefit of the highest first-pass collection rate. We are in fact the only RCM organization that has the privilege like doctor office follow-up, patients calling as well as pre-billing activities, making us the one-stop prior authorization destination for infusion service.

Offering a flexible prior authorization for infusion services with customizing our approach like robust reporting according to client’s protocol, (daily/weekly/monthly), no-cost dedicated account manager, complete operational transparency, etc. Our experts take care of complete prior authorization responsibility for infusion service including:


Authorization initiation- information is obtained in this first stage, which is required or essential for the treatment process. This then is followed by authorization initiation. The information which is collected includes patient name, DOB, ordering provider’s name, NPI, Tax ID, address, phone no along with insurance information. We further ensure a proper check on the diagnosis code, units for each service code, if ordering physician is PECOS certifies or not

Requesting authorization - this is the most critical part where documentation is been developed accurately collected through fax, call etc. after which verified and validated the documentation along with the authorization request is arranged. In this process, it is important to maintain constant oversight over all prior authorization requests that are outstanding

Continuous follow-up is made - our second last steps assure investigating to decide whether the patient is eligible based on payer requirements for prior authorization. Once this is done prior authorization is initiating through outbound calls, portal etc as per payers’ protocols/guidelines. Here waiting on the consent or denial of their request for ongoing authorization happen

Updating the authorization process- This concludes with providing additional documents/ data if requested by the payer. This completes by updating all the prior authorization results in the billing system.

Freeing up all your in- house staff so that they can focus more on other important work like patient care, PriorAuth Online experts offers the best prior authorization solution for infusion services with seamless operation and revenue generation.

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