Simplifying all Your Orthotics and Prosthetics Prior Authorization Challenges

Simplifying all Your Orthotics and Prosthetics Prior Authorization Challenges

The Orthotics and prosthetics coverage is subject to copay or coinsurance, while authorization is required for various devices varies from payer to payer. In fact for accruing orthotics and prosthetics prior authorization there are few requirements which needed to be accomplished like:

  • A prescription from the ordering physician dated before the delivery date.
  • Consideration of limitations based on the time period within which the item can be covered if supplied earlier.
  • Proper modifiers must be billed, e.g. KX, LT / RT, NU etc.
  • Coverage of devices also subject to qualifying diagnosis, e.g. orthotic shoes are not covered unless diagnosis states diabetic
  • Renovation, replacement and supplies may be eligible for separate reimbursement


With all these regulation for a successful orthotics and prosthetic prior authorization, one need complete authorization process knowledge along with up-to-date authorization regulation and years of practice too.

Finding a specialized partner that takes into account the evolving claims adjudication practices with DME billing, orthotics and prosthetics prior authorization is very difficult in today’s competitive world.

However, worry no more with PriorAuth Online. Offering a seamless transformation from tedious paperwork for documents to processes that encourage paperless transfer for better revenue cycle management, PriorAuth Online is the one-stop prior authorization destination. Powered by Sunknowledge Services Inc PriorAuth Online is a prior authorization platform for authorization initiation, follow-up and approval. Today serving more than 100s of satisfied clients PriorAuth Online is not only known for its effective and faster authorization closure but also, 100% prior authorization submission on the same day.

For a Successful Orthotics and Prosthetics Prior Authorization, PriorAuth Online Take Care of:

Detailed Eligibility Verification and Authorization Requirement Checking

  • Re-verification of eligibility with assigned codes
  • Updating detailed code specific benefits
  • Checking authorization requirements (Code Specific)
  • Creation of Service Estimates (Payer Specific and Reasonable and Customary)
  • Sending detailed written order/diabetic verification form and other paperwork to the doctor’s office for signature
Doctor’s Office Follow-up

Contacting doctor’s office for pending detailed written order/diabetic verification form and other paperwork

Authorization/Pre-Determination/Referral Initiation
  • Creation of Insurance Authorization Form
  • Requesting Authorization/Pre-Determination/Referral (Via Phone/Fax/Email)
Authorization/Pre-Determination/Referral Follow-up
  • Follow-up with the payer on Authorization/
  • Pre-Determination/Referral status
  • Completion of authorization form based on the outcome of the request

Offering task-specific prior authorization services, our experts also take care of:

  • Order entry (patients, providers, insurance, items, etc)
  • Eligibility verification (online/calling)
  • Prior authorization with patients calling and doctor’s office follow up for relevant documentation that needed for the process
  • Reauthorization
  • order Confirmation
  • Scheduling of delivery
Post billing services:
  • Claims management
  • Rejection management
  • Payment posting auto (with and without audit as well as manual)
  • Account receivable follow-up
  • Account receivable and denial management

Reducing complications in prior authorization services, PriorAuth Online provides the required flexibility in their platforms for easy submission of auth requests. A powerful partner that innovates and gives returns on time with simple solutions to everyday management of verification and authorization process, PriorAuth online ensures higher productivity metrics. With a service charge as low as $7 per hour, PriorAuth Online has other benefits like robust reporting, increasing your authorization rate by 1.5-2x, no binding contract and many more.

So if you are looking for seamless operational transparency for your orthotics and prosthetics prior authorization services with financial improvement, PriorAuth Online is the perfect destination.

To understand in detail how PriorAuth Online experts can bring a difference in your orthotics and prosthetics prior authorization services you can get in touch through mail or over a 'no commitment call', we are just a call away!

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