Administrative

Gather Patient Information: Collect and review patient medical records, diagnosis codes, and procedure details to support the pre-authorization request.

Verify Insurance Coverage: Confirm patient information and insurance coverage through verifying photo ID, insurance cards, and personal information.

Submit Pre-Authorization Requests: Prepare and submit pre-authorization requests to insurance companies, adhering to their specific procedures and requirements.

Follow Up: Monitor the progress of pre-authorization requests and follow up with insurance providers to expedite the approval process.

Communicate with Healthcare Providers: Collaborate with healthcare providers to obtain any necessary documentation, notes, or additional information required for pre-authorization.

Patient Education: Explain the pre-authorization process to patients, including potential out-of-pocket costs, and address any questions or concerns they may have.

Document and Recordkeeping: Maintain detailed records of pre-authorization requests, approvals, denials, and communications with insurance companies and healthcare providers.

Compliance: Ensure that all pre-authorization processes comply with relevant laws and regulations, including HIPAA (Health Insurance Portability and Accountability Act).

Appeals: If a pre-authorization request is denied, assist in the appeals process by providing necessary documentation and information to support the appeal