Prior Authorization
MedCycle Solutions Services
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100%”][et_pb_column type=”3_5″ _builder_version=”4.16″ custom_padding=”|||” global_colors_info=”{}” custom_padding__hover=”|||”][et_pb_blurb title=”Up to Date Regulations” use_icon=”on” font_icon=”R||divi||400″ icon_color=”#F58331″ image_icon_background_color=”RGBA(255,255,255,0)” icon_placement=”left” _builder_version=”4.18.0″ _module_preset=”default” header_font_size=”24px” body_font_size=”15px” hover_enabled=”0″ global_colors_info=”{}” header_font_size_last_edited=”on|phone” header_font_size_phone=”18px” sticky_enabled=”0″ header_font_size_tablet=”24px”]Our experts research and maintain up to date knowledge on new formularies, medications, policies, and CPT codes. We’re not just a service but also a resource for the practices we partner with. Our team will be available to answer questions related to topics such as: insurance deductibles and co-pays, mail order, and assistance eligibility while maintaining productivity, and HIPAA standards.
[/et_pb_blurb][et_pb_blurb title=”Clear Communication” use_icon=”on” font_icon=”R||divi||400″ icon_color=”#F58331″ image_icon_background_color=”RGBA(255,255,255,0)” icon_placement=”left” _builder_version=”4.18.0″ _module_preset=”default” header_font_size=”24px” body_font_size=”15px” hover_enabled=”0″ global_colors_info=”{}” header_font_size_last_edited=”on|phone” header_font_size_phone=”18px” sticky_enabled=”0″ header_font_size_tablet=”24px”]Once we have confirmed the status of the authorization, we get to work informing involved parties. Our experts will let the office know if the patient is approved or denied for the procedure. Additionally, when researching CPT codes to see if they require authorization for providers, we relay results in a timely manner.
[/et_pb_blurb][et_pb_blurb title=”Comprehensive Assistance” use_icon=”on” font_icon=”R||divi||400″ icon_color=”#F58331″ image_icon_background_color=”RGBA(255,255,255,0)” icon_placement=”left” _builder_version=”4.18.0″ _module_preset=”default” header_font_size=”24px” body_font_size=”15px” hover_enabled=”0″ global_colors_info=”{}” header_font_size_last_edited=”on|phone” header_font_size_phone=”18px” sticky_enabled=”0″ header_font_size_tablet=”24px”]Overall, this service includes these many prior authorization-related tasks:
- Monitoring DDE system for contract adjustments, payments, and error corrections.
- Managing patient support and service representation with patients and providers to establish equipment/procedures statuses and expedite orders.
- Performing QA on system defects to avoid member disruption.
- Scheduling appointments for in-house procedures along with outside providers and facilities.
- Verifying medical insurance, research denials, audit accounts, and post payments/denials.
- Analyzing and resolving incorrect payments, EOB rejections, and other issues with outstanding accounts.
- Monitoring claim balances in A/R in order to assure timely filing, appeals, and guidelines are meet.
- Protecting the confidentiality of patient’s health information from other members and personnel in compliance with HIPAA.