Prior authorization is an eligibility verification process, which requires health care providers to obtain approval from a health insurance provider before a specific service is delivered to the patient. Providers need to improve their prior authorization strategies to reduce cases of claims denials and optimize their revenue collection. Read along to learn more!
Eligibility and prior authorization challenges are fairly common in medical practice, and if you are managing a medical practice, you would have had your fair share. Let’s take a look at what prior authorization is about before exploring the tactics, tricks, and best practices for tackling it.
Prior authorization: what does it mean?
Prior authorization is an eligibility verification process, which requires health care providers to obtain approval from a health insurance provider before a specific service is delivered to the patient. For a service that requires prior authorization, if you don’t get the prior approval before rendering the service, the service will not qualify for payment. Thus, the process enables practices to reduce claims denials and optimize cash flow. If your prior authorization processes are poor, you will have more denials and a decrease in revenue.
Priority should be on front office operations
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