Prior authorization is no doubt is quite a complex affair. In the healthcare industry, this one term has always been making waves was ages and still continuous to be a problem area for many – Prior Authorization (PA). With staggering figures like $291k in write-offs and over $21 million in denied charges due to PA errors, understanding and mastering is really a art.  As it has not only become crucial for healthcare provider’s seamless billing operation but also constant cash flow sources.  

Understanding Prior Authorization: 

Prior authorization, or preauthorization, is a process employed by healthcare insurance companies to validate the necessity of certain medications, procedures, and tests prescribed by healthcare providers. Without obtaining pre-approval, providers risk non-reimbursement for treatments offered to patients. Payers often lean towards cost-effective alternatives, emphasizing the importance of obtaining permission before proceeding with any medical interventions. 

Though the authorization process is for the benefits of patients, given the time, complexities and potential for errors healthcare providers are increasingly turning to option like outsourcing. As outsourcing can not only significantly enhance efficiency but also help with accuracy along with other benefits like – 

  • Quality Assurance : Audit patient registrations, detect errors, and alert staff with recommended solutions.

  • Eligibility Verification and Benefits Mapping: Analyze data, detect errors, and automate benefit verification on all accounts.

  • Authorization Requirement Determination: Automate the process of determining whether authorization is required according to payer guidelines.

  • Constantly updating the authorization Status : Reducing the need for checks by you, outsourcing can help you with responses, denial numbers and staff work queues etc

  • Handling Authorization Denials:Authorization denials, which contribute to 80% of claim denials, demand careful handling, with when outsourcing can be taken care of easily.

  • Follow Guidelines: Adhere to payer guidelines to minimize denials and streamline the pre authorization process and more. 

In fact, today Sunknowledge Services Inc., is tone of the most reliable prior auth destination for major providers in the US. Taking care of all your pre auth responsibilities, Sunknowledge gets it all done within $7/ hour. From checking if prior authorization is required to identify who manages patient plan data and benefits while understanding payer-specific rules for submitting patient data; Sunknowledge ensures 100% authorization on the same day. Submitting accurate service and patient data while awaiting the payer’s response and provide follow-up data, Sunknowledge expert communicate pre-authorization results to the team and patients and do a lot more.