Prior Authorization (also referred to as ‘pre-certification’ or ‘preauthorization’, or simply ‘Prior Auth’ in short) is a vital component of the healthcare system, which involves obtaining approval from insurance providers before specific medical services, treatments, or prescription medications are administered to patients. This process is necessary to ensure that healthcare services are medically appropriate, cost-effective, and adhere to the insurance company’s policies and guidelines.
Managing Prior Auth requests is a time-consuming and hard task for a lot of practices. This is especially true for healthcare practices that are already struggling under a shortage of labor or rising operational cost. Prior Authorization requests can often be extremely difficult to fit into an already busy practice management schedule.
As an experienced and trusted provider of Prior Authorization services, we understand how to dive deep and offer specialized intervention that not only streamlines the workflow but also optimizes time & cost. Finding a dedicated vendor and creating an efficient precertification process is the key to ensuring better care delivery, patient relations and business growth.
Our Prior Authorization experts are highly experienced in quickly initiating a process that helps outpatient, physician practices, and hospitals to
- Efficiently manage high-volume Prior Auth requests for a wide range of services and procedures
- Save time and minimize the hassles of having to deal regularly with payers
- Free up important members of your staff, and helping them focus on core responsibilities
- Achieve maximum reimbursement through high accuracy
Advantages of hiring an experienced Prior Authorization partner
If you are looking for someone who can assist in delivering true value, and help you focus on more important responsibilities, choose a qualified and competent vendor who knows how to deliver end-to-end prior authorization services at the highest quality. Such an association brings multiple benefits with it, such as:
- Improved transparency on pre-cert reports and status updates
- Reduced errors and paperwork
- Fewer write-offs and denials
- Faster turnaround time
- More time for patients
- Reduction of collection cost
Challenges of the prior authorization services:
The main three challenges that most providers face in the Preauthorization process start with:
Constantly changing Prior Authorization regulations – With the continuous evolution of healthcare technology and medical science, the number of insurance plans is increasing every day, with their own norms and regulations. This makes it increasingly difficult for providers to keep up with the changes in Prior Auth requirements, resulting in a growing rate of misses and denials.
Working with outdated information – A Preauthorization request can often be denied due to outdated or incorrect information. When the doctor or pharmacist submits incomplete authorization data or uses an outdated form, it can lead to a reversal of the request. According to the latest research, 70% of payers stated their authorization requests were denied due to inconsistent guidelines.
Spending too much and too long on Prior Authorization – Prior authorization services can be frustrating and time-consuming. In fact, a survey has shown that 86% of physicians experience ‘high to extremely high’ Prior Authorization administrative burden due to the many caveats of the process. In fact, physicians have long expressed their dissatisfaction with the time they and their staff have to spend on getting their Prior Auths done.
Also, according to a recent survey by AMA:
- 90% of physicians reported that Prior Authorization processes caused a delay in a patient’s access to necessary care
- 44% of doctors said that PA requests “often or always” hold up care
- 26% of physicians stated waiting for three business days or more on an average to receive PA decisions from health plans
- While the average time spent on the overall authorization process can end up taking up to 45 minutes for each Preauthorization submission, it not only adds up the administrative cost for practices but also interrupts your patient care.
This is why you need Sunknowledge.
The Sunknowledge approach:
Taking care of the Prior Authorizations – starting from authorization initiation, to approval and follow-up, Sunknowledge experts help in closing all the gaps faster and more effectively.
Extending unparalleled support in Prior Authorization services for more than 18 years, we are your one-stop destination with 99.9 % accuracy and the highest productivity metrics. Following 100% HIPAA compliance guidelines, we ensure complete security of PHI and also help in reducing your operational cost by up to 80% in a secure and efficient manner.
The Sunknowledge edge in Prior Authorization:
- 100% PA submissions on the same day itself
- STAT requests completed in 15 minutes (max.)
- Regular requests completed in 24 hours (max.)
- 90+% approval rate for all PA requests initiated by us
- Instant increase of the current daily rate of completed requests by 1.5 – 2X
- 30-day FREE transition
- Real-time audits and custom reporting according to your protocol
Our success story:
We take pride in being the only Preauthorization expert to work successfully with one of our clients for obtaining Prior Authorization for a quasi-medical product like Botox that is primarily needed for cosmetic purposes.
Reducing your administrative burden for Preauthorization process is just a click away. Fill up the form below to schedule a free 1:1 discussion with one of our Prior Auth experts.
FAQ’s SECTION
What is the difference between pre authorization and prior authorization?
Known as precertification, prior approval or prior authorization, eventually both the terms means the same thing. Essentially your health plan will require prior authorization for selected services before receiving them, not applicable in an emergency.
Why do denials happen in prior authorization?
There are multiple reasons for it! An insurance company can deny requests with the physician not performing the steps according to prescribed protocols. Also, filing the paperwork wrongly with missing information such as incorrect service code and date of birth and not having a consistent contact with the payer office are some of the reasons.
How to check the status of prior authorization?
The status of your prior authorization is checked by calling the Customer care number which can be found on the back of your member identity card.
Is there an appeal for prior authorization denial?
The initial level appeal involves the physician and the patient contacting the insurance to reconsider the denial. Also, the doctor may contact the insurance plan’s medical reviewer as part of peer to peer review for challenging the decision made earlier.
Can I improve my collections with accurate prior authorization?
Yes, accurate prior authorization upfront eliminates a lot of back end work with denials and hassles in collecting your payments on time. Going back and forth is negated with a transparent approach in practice management that accelerates collections in the long run.
What makes Sunknowledge unique?
Knowing the in and out of the industry, we know how to get your prior authorization approved. In fact, we have a 90% approval rate with our mastery in prior authorization services as we offer exceptional support at next door rates.
Presently, Sunknowledge has no transaction charges, training or installation costs, provides dedicated support. Let our experts share our references with you to demonstrate our quality. Our team will be glad to give you a complete preview on what difference we bring in with our comprehensive prior authorization action plan.