Prior Authorization
MedCycle Solutions Services
Before your practice can begin a certain procedure, it may need to be approved or certified in order to be covered by insurance. When you run a busy practice, you don’t have time for all the back-end work that comes with pre-authorization. Filling out the proper paperwork is a time-consuming task, and it slows down the entire process if not completed correctly.
Clients should look forward to a number of benefits when partnering with MedCycle experts:
Up to Date Regulations
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.
Clear Communication
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.
Comprehensive Assistance
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.
