Prior & Retro Authorization

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  • Prior Authorization is the process of obtaining Payer approval before the provider performing the service and it’s a mandatory part of the revenue cycle for a healthcare practice.
  • Payer based staffing to navigate payer dynamics. Our dedicated staffs are responsible in payer-based nuances, learning their specific payer needs. Our staff also establish relationships with their counterparts at the payer, to expedite auth request.
  • Our technology-based solutions help us to improve our efficiency on Eligibility verification and Prior auth request by Prepopulating the patient information in forms for each payer. We leverage automated tools using payer online forms for the prior authorization need to optimize the results
  • Our leaders understand payer medical policy guidelines for treatment decisions and establish the medical necessity for Payer justification for prior authorizations.
  • Our workflow management tool tracks and monitor these Eligibility request and prior authorization request, ensuring the rigorous follow up with payers performed consistently.
  • Our data mining tool will help clinics to outline the requirement of treatments and medications for frequent diagnoses require a prior authorization by payer and the accepted alternatives. This guide enables saving physicians time by regulating them toward medical necessity services that the insurance company will accept.