There are a lot of administrative pain points that providers have to deal with in the medical field, and one of the most common issues is a prior authorization. This can be a frustrating hurdle that providers need to clear before they can perform a test or dispense certain medications for their patients. It is helpful for the practice to utilize expert prior authorization services to ensure the claims will be reimbursed.
What Is Prior Authorization?
Prior authorization is a process used by insurance companies to determine if a prescribed product or service (imaging studies, medications, surgeries etc.) will be covered. The prior authorization ensures that the service will be paid in full or in part. For example, once a provider orders an MRI for a patient, the provider may have to reach out to the insurance company to see if they will cover the cost of the MRI..
According to fiercehealthcare.com healthcare professionals could have saved $13.3 billion on administrative waste in 2020. Prior authorization can be a frustrating hurdle because it can delay the process of patients receiving the care they need. Therefore, it is important for doctors to understand how prior authorization works and how they can maximize the chances of getting the claim covered. A service like DataMatrix can help the practice’s bottom line.
How Does Prior Authorization Work?
There are several steps involved in the prior authorization process. They include:
- The doctor will usually try to order an Imaging scan or a specific medication. After the order is put through, the person running the task will be alerted to the prior authorization status of that medication or test. For example, if a doctor orders a medication or test, the practice will need to check with the insurance company for prior authorization.
- At this time, the practice needs to start a prior authorization process. The exact information required to submit the request can vary from insurance to insurance. Typically, this is a process that is handled over the phone, using a secure email server, or through fax messages.
- It is not unusual for a prior authorization situation to take a few days or a few weeks to get resolved. It may require multiple phone calls, and it could require a lot of waiting.
- At the end of the process, the insurance company will either approve the prior authorization request or deny it. If the claim is denied, the doctor may have an avenue for appealing the decision.
Because this process can take such a long time, it is important for doctors to understand every option available to them.
Professional Services Can Streamline the Process
Even though it can be frustrating to go through the prior authorization process, this is not something that medical practices have to go through on their own. There are professional services available that can make the process easier.
Doctors can outsource prior authorization services to a specialist to understand the most common reasons why a prior authorization might not be approved. They can anticipate these issues ahead of time, avoid these obstacles, and make it easier for patients to get the care they need.
This can also take a lot of stress off of the shoulders of practice because they do not have to do as much paperwork. Providers can spend their time helping their patients, focusing on making the best possible medical decisions for their needs.
Trust DataMatrix Medical for Prior Authorization Help
If you want to make sure that your patients get the care they need, it is important to work with professionals who can handle the prior authorization process for you. At DataMatrix Medical, we have a tremendous amount of experience working with a wide variety of medical practices and we can help you make it easier to get your prior authorization processed. If you would like to learn more about how he can help you, contact us today to speak to a member of our team.