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Answer to All Your Prior Authorization Complexities

According to the van Halem Group, CMS has updated the Federal Register on the 11th of February to add certain L codes to the prior authorization list for DMEPOS.

In fact, in the first phase of the implementation on May 11, CMS will limit the prior authorization requirement to California, Michigan, Pennsylvania, and Texas, one state in each of the four DME MAC jurisdictions. Whereas phase two, on Oct. 8, CMS will be expanding the program to the remaining states in all four jurisdictions.

As part of the prior authorization process, the providers must submit all prior authorization requirements that include evidence that the item complies with all applicable Medicare coverage, coding, and payment rules. Such evidence must consist of the order, relevant information from the beneficiary’s medical record, and relevant supplier produced documentation. As the rules and regulations in the prior authorization process are frequently changing, it becomes impossible for in-house authorization experts to keep a complete track of it.

Other problem in hiring in-house prior authorization expert:

  • In-house prior authorization expert is an expensive business to deal with
  • Administrative and other office work often dilute the attention of the in-house staffs
  • Lack of continuous follow-up with payers
  • Not staying updated with the essential points of care payers
  • Lesser accuracy rate in the documentation and many more

This is why today, healthcare provider opts for outsourcing their prior authorization process for better result.

PriorAuth Online- The Perfect Outsourcing Destination for Prior Authorization:

Offering customized prior authorization solution that helps all our clients experience a seamless prior authorization process for more than 20 specialties, PriorAuth Online is powered by Sunknowledge Services Inc.

With proper guarantee reimbursements and a 99.9% accuracy rate in the prior authorization process, PriorAuth Online experts ensure the additional initiative in providing a hassle-free authorization service. Ensuring 80% operational cost reduction for all the clients, the experts are known for closing all the prior authorization gaps faster and efficiently.

Reducing the time consumed in the administrative work involved in the prior authorization process, PriorAuth Online has the highest productivity metrics.

Carefully monitoring, analyzing, and improve the prior authorization process to avoid denial and rejection, its authorization process, which starts at the physician’s office, can be divided into:

Authorization initiation- information is obtained in this first stage, which is necessary for the treatment process. This is then 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 also ensure a proper check on the diagnosis code, units for each service code, if ordering physician is PECOS certifies or not

Requesting the authorization - this is the most critical part where documentation is being completed accurately collected through fax, call, etc. after which verified and validated the all the needed documentation for the authorization process along with the authorization request is done. In this process, it is necessary to sustain constant oversight over all prior authorization requests that are outstanding

Continuous follow-up is made - our second last steps ensure investigating to resolve whether the patient is eligible based on payer requirements for prior authorization. Once all the above process is done, prior authorization is initiating through outbound calls, portal, etc. as per payers’ protocols/guidelines. Which end up by waiting on the approval or denial of their request for ongoing authorization is followed next

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

So if you are looking for a seamless prior authorization process with an effective revenue generation solution, PriorAuth Online is the perfect one-stop prior authorization destination.

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