Certain medical services must be approved or permitted by insurance companies before physicians treat the patient. This is to ensure that the treatment being provided is medically necessary. Not all procedures require prior authorization; each insurance company will issue a list of services that require prior authorization.
Following review of the treatment plan submitted by the provider, the Insurance Company's Utilization and Management Review department would grant the Prior Authorization. Emergency cases are exceptional. Prior Authorization, often known as pre-certification.
Importance of Authorization :
IMBS expert team proactively initiates the prior authorization process at least 15 days prior to appointments, ensuring timely approval of medical necessity treatments and minimizing the risk of treatment delays or re-scheduling. In addition, The Prior Authorization method improves revenue and allows appropriate reimbursement for healthcare services.
Prior Authorization Workflow Process :
Authorization does not guarantee payment; however, if the claim is denied, we can file an appeal with the authorization number to seek reimbursement from the insurance carrier. Lack of authorization might result in costly consequences for both the patient and the healthcare practitioner. Therefore, having a partner like IMBS handle your medical billing and authorization procedure is the key to higher reimbursement.