The CMS has already finalized a new rule that allows providers, payers and patients have electronic access for all pending and active decisions with prior authorization. It means that patients will no longer have to struggle with the providers, locate ancient fax machines for taking data possession. True, a prompt approach to health care arrives with the implementation of the API’s.
A transparent exchange of health data between providers, patients and payers leads to effective streamlining of earlier laid back processes. The payers now have 72 hours to decide on any decisions of urgent prior authorization application and a week’s time for non urgent prior authorization requests.
Increasing healthcare costs and labor shortage makes it difficult in finding a team of experienced billers and certified coders. Achieving a hassle free practice management experience can be challenging for a lot of healthcare providers. Every year providers lose millions with faulty PA methods with:
♣ Incorrect verification of Patient data
♣ Proving medical necessity properly
♣ Incorrect use of Modifiers
♣ Inept Documentation
Your search for a practice management partner ends here
Extending unparalleled support in prior authorization services for more than ten years, we are your one stop destination. Our team is proud of our excellent references, testimonials from leaders across the healthcare industry.
We have experienced resources performing all the pre billing activities by entering all the required data , checking eligibilities on time, submitting and getting the prior auth approved, following up with doctor’s office for necessary documents, contacting payers on the status and updating the auth outcome in the client billing system.
♣ Maximum accuracy and the best productivity metrics
♣ Doing it for the last 10 years and with excellent references
♣ 100% PA submissions on the same day itself
♣ 90% approval of your PA requests
♣ Accurate PA guarantees 97% collections in the next 30 days
♣ Increase current rate of completed requests by 1.5 – 2X
♣ 100% HIPAA-HITECH compliance
♣ Rapid claim status analysis in denial management
♣ Turnaround time less than 48 hours max.
♣ Low service fees with no hidden cost
♣ No binding contracts
♣ Over 100’s of client references
♣ Real-time audits and custom reporting
At $7 per hour, we complete 3 prior authorization rounding up to 25 authorizations in a day with one person working only for you.
Our Success Story: Botox Prior Authorization
We have been successfully with one of our clients for obtaining prior authorization like the Botox, primarily needed for cosmetic purposes. We provided our specialized intervention and a great deal of persistent approach with our complete understanding of the Rx caveat. As it required more effort than any conventional procedure, we completed all the necessary functions with:
♦ Checking eligibility
♦ Authorization initiation
♦ Following up on the PA request
♦ Acknowledging and obtaining authorization
♦ Scheduling the delivery of the drug
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 with your 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.