Pre Authorization

Before providing treatment, healthcare providers need to get approval from a patient’s insurance company. This is called Pre-Authorization. It’s a crucial step that confirms whether the insurance will cover the cost of the required treatment. By doing this upfront, we can speed up the claims process and make everything more efficient. The goal is to avoid surprise costs and ensure that the necessary treatment is covered by the patient’s insurance. At One O’Seven RCM, our team of experts is here to guide you through every step of the medical billing process, including Pre-Authorization.

Steps Involved in Pre-Authorization

1. Service Check:

It needs to be checked for some specialized treatments, surgeries, diagnostic tests like CT scan or MRI that require prior authorization from the insurance company or not.

2. Submitting Request:

The accurate request is being submitted to the insurance company via call, fax or online.

3. Determine Coverage:

The health insurance panels verify that the treatment and prescription is covered by the patient’s plan.

4. Decision:

After reviewing all the details and requirements, the health insurance companies may approve or deny the request. If approved then authorization number is provided.

Challenges Faced in Authorization Procedures

There are numerous challenges in the authorization process that can impact healthcare providers, insurers and patients. Below are some common challenges:

• Unclear payer guidelines and Provider-Patient miscommunication

• Due to complex requirements of payer, it’s a time-consuming process which increase administrative burden

• Due to slow payer response, there is a challenge of urgent care

• Due to lack of integration between EHRs and payers there is a chance of more denials

• Appeals and tracking difficulties.

• Insurers may not clearly disclose Authorization requirements, leading to provider guesswork.

• Proactive patient eligibility verification

• Use EHR integrated software to submit request electronically

• Implement AI-driven solutions and use centralized tracking

• Maintain clear and complete documentation with regular audit

• Train team on payer policies and assign dedicated specialist

• Establish direct contacts to resolve issues faster and expedite urgent cases by scheduling direct discussions between providers and insurer medical directors.

• Expedite authorizations for emergency or oncology treatments using fast-track options.

• Monitor metrics and improve continuously

• Create a prior authorization checklist

• Submit missing information or additional evidence within payer deadlines

Collaborate with One O’Seven RCM for Streamlined Authorization

Focus on what matters most—patient care, and we’ll manage the rest

There are numerous challenges in the authorization process that can impact healthcare providers, insurers and patients. We understand all those challenges. Our goal is to assist our clients by providing exceptional services. Partner with One O’Seven RCM today and experience the difference!

• Dedicated team

• All hour services

• Transparency

• Professionalism

• 100% Data security

• Accurate documentation

• Regular updates

• In accordance with HIPAA and Industry standards

• Reduce administrative burden

• Increase cash flow

• Maximize reimbursement

• Innovative and customize solutions