The process of securing prior authorization (PA), pre authorization or precertification for medical services is often complex and time consuming. In fact, even after so many years, prior authorization is the reason for frustration and frequent burnout for more than 63 % of people. Also, in a recent report, it is seen that the burden of prior authorization has increased about five times more among physicians, patients, staff etc today than what it was five years back. Though systematic measures are taken to reduce the burdens but to ensure seamless authorization operation one must keep the following points in mind starting from-
- Have a complete understanding of the Policies: Understanding the payer's policies is the first step to streamlining the PA process. With constantly changing regulations, and industry mandates, managing various regulations can not only be confusing but also time consuming. With each insurance company having different requirements and guidelines, keep updated about these policy changes in fact can prevent delays and denials.
- Stay Organized: Handling multiple PAs can be a chaotic state of affairs for many. Therefore, maintaining an organized system to track each request, date submitted, patient details, and the status of the request can be quite beneficial and also comes in handy. Furthermore, it will not only ensure that no PA is overlooked but also makes it easier for better follow up.
- Leverage Technology and software facilities: There are numerous software solutions available to help manage PAs, which aid in automating the submission process, tracking status updates, and managing documentation thus, significantly reducing manual work and potential errors. Investing in a robust, user-friendly PA management tool can drastically improve the prior authorization operation efficiency.
- Train and up-to-date Your Staff: Consistent training for your team is crucial, especially in today's competitive era. Being a dynamic domain where rules are often changing – regular training sessions, ensuring your staff stays up-to-date with the latest regulations and procedures in fact improving pre authorization efficiency and accuracy.
- Ensure efficient Documentation: Prior authorizations often require detailed documentation to validate the need for a specific treatment or medication. Ensuring you provide all necessary information is extremely essential in the initial to avoid back-and-forth communication, which can delay the approval process and also can be the reason of rejection at the time.
- Be Proactive: Don’t wait until the last minute to start the PA process. Always anticipate the need for a PA and start the process as early as possible for faster authorization approval. This will not only give you ample time to address any issues that might arise but also prevents unnecessary delays in patient care.
- Communicate Effectively: Clear and effective communication with insurance companies is vital. Ensure all submitted requests are clear, concise, and contain all required information. Also, maintain open lines of communication for better understanding and transparency in authorization operations.
- Follow Up Regularly: Prior auth requests can sometimes get lost in the shuffle. Regular follow-ups ensure your request remains at the forefront and can help expedite the approval process.
- Know When to Appeal: If a PA is denied, it's essential to understand why and when to initiate an appeal further. Knowledge of the appeal process and its requirements can turn a denial into an approval promptly.
- Outsource When Needed: If your practice is overwhelmed with PAs, consider outsourcing is the best and most convenient solution today.
However, choosing a specialization in PA management is the question that most providers ask for which Sunknowledge Services Inc can help.
Sunknowledge the ultimate pre authorization support:
streamline your PA process, leading to faster approvals, reduced administrative burden, and improved patient satisfaction, Sunknowledge for the last 15 + years is known for delivering state of art solutions for many leading names in the industry. Ensuring 100 % authorization submission on the same day and ensuring a faster approval rate, Sunknowledge today deliver the best authorization support solution at a cost effective rate that no other RCM organization can meet.
So if you are looking for an alternative to manage our complex prior auth process call the expert now and find what works best for your specific needs.
