PRE - AUTHORIZATION
Get the agreement nod from the payer for the healthcare service even before the service is performed. Pre-Authorization is a sure way to prevent payment delays, part-payments and denials. An authorization number on the claim form at the time of submitting the claims is the best route to a clean claim.
The key to Pre-Authorization is the obtaining of the correct CPT code which is often a daunting task. So, leave it to us. QWay’s trained and highly professional team works on getting the correct CPT by checking with the physician and working out the most possible scenarios. So stop chasing claim payments. Pre- Authorization means prompt payments.
Your coders may have done their job, but it will be up to the provider to obtain the necessary authorization. A claim denial or part –payment affects the provider and which is why our focus on getting the Pre-Auth for the procedure is complete and absolute when you outsource it to us. We work with physicians, hospitals, insurance payers and outpatient facilities and ensure the necessary pre-certification requirements are intact to obtain the Pre-Auth.
A Pre-Auth can prevent:
- Prevent payment delays and denials.
- Ensure the patients get the maximum benefit under the policy.
- Avoid pay and claim.
- Enable a better financial counselling session with the patient.
QWay’s Pre-Auth service will have you free up time to focus more on patients and less on paper-work.
frequently asked questions
1. What does pre-authorization mean?
The healthcare provider obtains permission from the healthcare insurance payer of the patient before performing certain procedures. This is to put forward the fact that those procedures are medically necessary for the patient in question.
2. Does pre-authorization guarantee payment after the procedure is done?
No! The pre-auth does not mean that the payment will be guaranteed without any delay. But it sure makes the process smoother than the usual one. Most of the providers ensure that the pre-authorization is done to take advantage of faster and hassle-free payments. Here the medical biller must ensure that the billing has been done through the insurance pathway.
3. What documents are needed to get the pre-authorization?
Several documents pertaining to identity proof of the patient, provider details, and other clinical records to prove the medical necessity are required. Usually, the intricate details depend on the needs of the insurance provider. However, these basic points mentioned above are commonly seen.
4. Why choose QWay for your pre-authorization services?
QWay makes the complicated process easier by ensuring that each of the forms is submitted accurately. The instances of pre-authorization for even prescription drugs are increasing by 20% every year according to a report of the American Medical Association. So it is advisable to brace yourselves for the future while the time is ripe.