All hospital and health systems based outpatient services require some form of prior authorization. It essentially means that procedures regardless of location requiring an assistant surgeon, co surgeon and even an anesthesiologist in an outpatient setting may require a standardized prior approval process.
Different procedures requiring health systems prior authorization
- Cosmetic or reconstructive surgery and other procedures
- Pulmonary rehabilitation and outpatient cardiac treatment
- All home healthcare services including agency visits, sleep studies, hospice care and uterine monitoring excluding home visits that are billed as an E&M service.
- Ambulatory surgery center based infusion services as well as associated medications
- Genetic testing and Elective transportation services
- Durable Medical Equipment Services
- Stem cell and organ transplant procedures
Lack of experience in managing prior authorization
It is critical to note that all of the mentioned services are complex and the processes involves extensive payer pursuit and understanding of individual claims adjudication mandates. Lack of expert resources are seriously adding to the woes of many health systems.
Rising backlogs, denials are a serious disadvantage for many health systems at present. Finding a reliable vendor that can deliver actionable support in hospital and health systems billing can be a difficult task. On the other hand, a genuine vendor can offer immense value and can help you as a health systems provider to focus on your patients a lot better without worrying about payments in the long run.
Your wait is over with Sunknowledge by your side
We are unique as we help the providers anticipate prior authorization needs well in advance. We deliver unmatched support with
- Non urgent Pre service requests
- Urgent (Expedited) pre service requests
- Concurrent review requests
- Post service requests
We make sure that our team abides by a payer’s clinical review criteria which they use to make prior authorization decisions. Our resources work with different procedures and understand how to work with different payers and will transform your health systems prior authorization process. We guarantee
- Maximum accuracy and the best productivity metrics
- Doing it for the last 15+ years and with excellent references
- 100% PA submissions on the same day itself
- 90% approval of your prior authorization requests
- Our Accurate prior authorization ensures 97% collections in the next 30 days
Knowing the in and out of the industry we are able to do prior authorization for you on an a la carte basis. At $7 per hour, we complete 3 prior authorization rounding up to 25 authorizations in a day with one person working only for you!
We do it all with:
- Verifying the eligibility
- Initiating the authorization
- Following up on the PA request
- Obtaining and acknowledging the authorization
- Scheduling the treatment or drug delivery
A Sunknowledge expert will love to share our excellent industry references with you anytime! Get to know how we intend to work on your health systems prior authorization process as a reliable operational extension.
Get rid of your prior auth worries with us