Prior Authorization

Another greatest contributor to lost revenue is the failure to obtain a referral or authorization before performing a procedure. The most common denial in medical billing reimbursement rates is Pre-Authorization, Prior Authorization, Pre-Certification, and Notification. Not all services and procedures require a referral or pre-authorization. However, if a referral or pre-authorization is required and is not obtained, reimbursement for the procedure is put at risk.

Authorization is getting a medical service(s) authorized by the insurance carrier. Providers or Medical billing companies must contact insurers in advance and obtain a certification number to be reimbursed properly. These processes result in an authorization and referral number that providers/billing companies must use on claims submitted for payment.

Billing Nexus is well aware of the Authorization and Referral process. We consider and manage it as a special project in Medical Billing Cycle because of the time and costs associated with it. Our Authorization Specialists have wide-range knowledge of functionalities and compliance with payer contractual requirements. We identify, verify eligibility, obtain insurance benefits, and ensure pre-certification, authorization, and referral requirements through all paperwork and research relevant to each case from the payers.

We Obtained prior authorizations and referrals from various payers by submitting clinical information via fax and online payer’s web portals or by speaking directly to a case management representative. We ensure end-to-end, timely, and accurate submission of prior and retro authorization and referral requests to the payers. We pledge to make everyone aware of any changes or implementations that may impact your financial growth.