Allergy and Immunology Prior Authorization Services

The surge in prescribed Allergy and Immunology procedures covered under Medicare/Medicaid has burdened practices with an increasingly cumbersome prior authorization (PA) process. Recognizing this challenge, dedicated allergy and immunology prior authorization services have emerged as strategic partners for practices drowning in paperwork.

As trusted partners to leading health systems and suppliers, we seek to liberate your practice from the shackles of administrative complexities, enabling you to focus on what truly matters – value added care.

But before we look at our prior authorization support for Allergy and Immunology practices, let us explore the challenges facing these practices.

Pre-approval Challenges: A Wake-Up Call for A&I Practices

  • On an average, practices handle 45 PAs per physician per week
  • Nearly two in five or 35% of physicians have staff who work exclusively on PA
  • Using physicians’ assistants and certified nurses to fill in pre-approval requests is an incredible waste of resources. These highly trained and valuable staff should be reserved for the actual needs of your operations – handling large volumes of tests or patient visits.
  • Here are some challenges that come with Allergy and Immunology treatments or testing regarding insurance approval and compliance.Test-Specific Challenges:
    • Lack of Standardization
    • Specificity of A&I Testing
    • Time-Sensitive Nature of Testing

Medication-Specific Challenges:

  • Limited Coverage for Specialty Medications
  • Off-Label Use Challenges
  • High Costs of A&I Medications

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Procedure-Specific Challenges:

  • Limited Coverage for Procedures
  • Bundled Payments Complexity
  • Evolving Treatment Landscape

Systemic Challenges:

  • Lack of skilled professionals
  • Excessive cost of in-house PA professionals
  • Compliance & payer guideline complexities

The PA process, however, is even more burdensome than this list would suggest. Many of the components in the PA process like Doctor’s office follow-up, re-authorization, managing faxed documents and dealing with Insurance help desks are too tedious for the in-house staff to handle. This has led many allergy and immunology practices to outsource their prior authorization requirements.

Outsourcing prior authorization for immunology helps practices focus on their core competencies and improves turnaround time and reduces costs.

Outsource Prior Authorization Services for Allergy and Immunology: Here’s Why

Allergy and Immunology Prior Authorization companies have increasingly come to the forefront due to their positive impact on practices.

  1. Prior Authorization Burden:

With cutting-edge tools, automation, and a vast pool of trained specialists, our services effectively clear out backlogs and denied requests.

  1. Preventing Claim Denials:

A well-optimized insurance approval process significantly reduces trouble with follow-ups and prevents claim denials.

  1. Revenue Impact:

Outsourcing accelerates the prior authorization process, leading to faster approvals and improved patient outcomes. This streamlined approach allows practices and laboratories to handle a heavier workload, increasing their turnover.

As a leader in the healthcare lifecycle management industry, we have successfully mitigated the prior-approval burden for our partners.

Comprehensive support in prior authorization for Allergy and Immunology practices

Authorization Initiation:

  • Calling up insurance to find the authorization filing procedure and turnaround time
  • Gathering prior-authorization form and relevant medical documents from the providers
  • Submission of the authorization request (fax/online/call) to the payer along with
    relevant documentation (if required)
  • Tracking of Fax receipts

Authorization follow up – Communicating with the payer to check the status of the authorization as per the turnaround time protocol of the payer. It also involves sharing additional notes as per payers’ requirement

Acknowledgement of Authorization approval – Updating approved authorization in the providers’ practice management system with the start and end date for the Authorization approval, service information and provider information

We provide complete RCM (Revenue Cycle Management) support, from administrative services like claims administration and credentialing to analytics including drug utilization analysis and payment reconciliation.

Our specialized practice management services like scheduling, eligibility verification, prior auth. and customer support helps revamp and optimize the entire insurance approval process.

In fact, we are the only Revenue Cycle Management company specializing in pre-certification. We assure:

  • Guaranteed reduction of operational cost by up to 80%
  • Prompt services with a consistent accuracy rate of 99.9%
  • 150 to 200% increase in rate of completed requests

Our experience in adjudicating claims for large Payers is among the reasons for our success.

Besides immunologists and allergy medicine specialists, we also provide services to:

Providers – Hospitals, Nursing Homes, Skilled Nursing Facilities, Physicians, Home Health Care, Ancillary Providers and Pharmacies

Payers – Commercial Plans, MA (Medicare Advantage) Plans, Medicaid HMOs, MAPD/PDPs, IPAs, MSOs and TPAs

Complete Prior Authorization Support for Allergy and Immunology Practices

This is how we achieve industry leading prior authorization approval figures for our partners:

  • Expert Resources: Our team specializes in obtaining prior authorization for specialized niches like Allergy and Immunology practices that have specific requirements.
  • Tailor-made processes: We tailor our process to suit the unique needs of your practice and ensure accurate submissions, minimize the risk of rejection.
  • Comprehensive Documentation: Each PA request is supported by thorough documentation, including medical records, family history, and lab reports. AI driven document management systems ensure credibility and transparency.
  • Constant Updates: Staying informed about Medicare coverage updates is crucial. We monitor policy changes to provide the most up-to-date information to our clients, mitigating the impact of policy churn.
  • Appeals Assistance: In case of denials, our team provides comprehensive assistance in the appeals process, navigating complexities for a favorable resolution.

From insurance approval to compliance assistance, we help navigate the entire Pre-Authorization process.

Why Choose Sunknowledge Services for Allergy & Immunology Practices

  • 24/7 Support for Regular and Stat PA Requests: Our responsive service ensures a maximum 24-hour turnaround for regular PA requests and a maximum of 15 minutes for STAT PA requests.
  • Immediate Reduction in Collection Cost: Experience an 80% reduction in collection costs immediate by partnering with us.
  • Liability Insurance Coverage of $3M: Your practice gets comprehensive liability insurance coverage of $3 million for added peace of mind.
  • Flexible Contracts and Proven A/R Recovery Process: No-binding contracts and a proven accounts receivable recovery process demonstrate our confidence in helping your practice grow and thrive.

Choose from a whole suite of RCM services from billing and coding to A/R and denial management for Allergy and Immunology. Our tailored services and processes suit the specific needs of your practice.

Learn more about how we eliminate prior authorization hurdles for Allergy and Immunology practices by scheduling an obligation-free call with our experts today.

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