Outsourced Prior Authorization Services
Prior authorization services means getting approval from the insurance company before giving treatments, procedures, or medicines. This makes sure the patient’s insurance will pay for the service. Old ways of handling prior authorization take a lot of time. Doctors fill forms, wait for answers, and this delays patient care, impacting 1 in every 4 patients and causing physicians to report care delays. It is tiring and hard for healthcare workers.
Did you know that over 80% of rejected claims could have been avoided? New systems make it easier. Automation helps fill forms and track requests quickly. Outsourcing lets experts handle the process.
This saves time, money, and reduces mistakes, with practices saving over 50% in prior authorization administration costs or up to 40%. Patients get care faster, with approvals potentially moving from a week to just 3 days or even less than 2 full days.
Common Prior Authorization Roadblocks & How to Fix Them
Getting prior authorization (PA) approval can be tough. Here are the main reasons for denials and how to fix them:
🚫 Cost Concerns: Insurance may prefer cheaper treatments, like generics over brand-name drugs.
🚫 Medical Necessity Issues: If the request doesn’t clearly show why the treatment is needed, it may be denied.
🚫 Paperwork Mistakes: Missing details, typos, or wrong billing codes can lead to rejections.
🚫 Coverage Limits: Some treatments (like cosmetic procedures) may not be covered at all.
🚫 Lack of Info: Not providing enough details about the treatment can result in denial.
🚫 Wrong Timing: If a test is done before getting approval, payment may be denied.
How to Get PA Approval Faster
✅ Complete Documentation: Clearly explain why the treatment is needed, including diagnosis and history.
✅ Use EHR Systems: Electronic health records help submit PAs faster and reduce errors.
✅ Keep Patients Informed: Let them know about possible delays so they’re prepared.
✅ Work with Insurers: Communicate with payers to fix issues quickly and improve approval rates.
Our Outsourced Prior Authorization Process
Collect Patient Information
Precise data gathering makes the process error-free.
Check Insurance Coverage
Ensures there are no billing surprises
Submit Authorization Request
Complete and accurate submissions improve response time.
Confirm Approval
Faster approvals mean improved cash flow.
MZ Billing’s Prior Authorization Services
MZ Billing helps with insurance approvals by working with a team of experts who work with all Government and Private insurances like Cigna, Humana, Medicare Advantage Plans, Medicaid, Aetna, and other commercial insurances based on practice protocols. This ensures a higher rate of approval, with practices achieving less than 1% denial rates compared to a national average of 27%, and an accuracy rate of 99.4%. We also guarantee complete confidentiality and HIPAA compliance. Our team offers 24-hour capabilities with 100% backup, meaning no sick days or time off will interrupt your service. We can seamlessly work within your existing EHR system, including athena, ModMed, NextGen, and eClinical Works.
We start the approval process by making calls or uploading documentation in the insurance portals. This helps to get permissions for procedures on time, accelerating authorization processing by up to 30%, which contributes to improving the practice cash flow. If an extra review, like a peer-to-peer, is needed, we will inform your practice early to avoid last-minute issues or denials. You will benefit from a dedicated team and project manager assigned to your account, ensuring consistent communication and personalized support.
Pre-Authorization Services
We make the Pre-Authorization process easy for you. Our team handles all the paperwork so you don’t have to. This saves time, avoids delays or rejections, and streamlines the approval process. We work to get approvals fast and help your practice avoid disruptions.
Checking Insurance Coverage
We check what the patient's insurance covers before starting treatment, reducing surprises and minimizing Prior Authorization Stress. Our experienced billers know how to analyze and work with various insurance plans, ensuring every detail matches payer criteria.
Verifying Medical Necessity
Our team checks if the treatment or procedure meets medical necessity criteria. This helps avoid insurance denials, making sure only essential, cost-effective services are provided. By doing so, we maximize revenue and keep your operations running efficiently.
Patient Eligibility Verification
We confirm if a patient’s insurance is active and valid for the requested service. This prevents confusion, billing delays, or claim rejections, ensuring patients are appropriately covered for their care.
Handling Medication Issues
If a patient needs medicine not covered by their plan, we step in to review prior authorization forms and verify the status of medications. We work hard to secure approvals so patients receive the medications they need while reducing payer denials.
Appeals and Claim Follow-Ups
When claims are denied, we manage the appeals process and monitor prior authorization status updates to fight for approvals. With diligent follow-ups, we recover payments for your practice and resolve issues effectively.
Accurate ICD-10 Coding
We use the correct ICD-10 codes for treatments, ensuring claims are processed without issues. Keeping up-to-date with coding standards significantly boosts acceptance rates, helping practices deal smoothly with Medicare Prior Authorization or Medicaid Prior Authorization.
Tracking and Monitoring Claims
We actively monitor prior authorization status in real-time, giving you full visibility of each claim. This allows us to resolve delays or problems quickly, making the process as smooth and efficient as possible.
Why Outsource to us as Your Prior Authorization Company?
Outsourcing your authorization tasks simplifies operations and reduces overhead costs, making it easy to meet payer criteria without burdening in-house staff. This allows the practice to lower its operational expenditure while staying focused on patient care.
Key Advantages:
Get Paid Faster – We speed up the approval process, so insurance pays quicker. This helps your clinic or hospital maintain better cash flow, increasing initiated prior authorizations by 30% month over month.
Happier Patients – Patients don’t have to wait long for treatment. This improves their overall experience and satisfaction with your care, making them 20% happier.
Adjust to Your Needs – We can easily handle more or fewer cases, depending on your workload. This flexibility helps you manage busy periods efficiently.
Safe Patient Information – We protect all patient data with strong security measures, ensuring compliance with rules like HIPAA for confidentiality.
Save Money – By outsourcing, you save on hiring and training staff to manage authorizations in-house. Our clients save over 50% in prior authorization administration costs or up to 40%. There are no setup fees or long-term contracts.
Clear Insights –
We provide detailed reports that track the process and help identify patterns, allowing you to make better decisions and improve services, including denial rate analysis and CPT code analysis. Proudly serving healthcare providers across all 50 U.S. states. We specialize in healthcare, our prior authorization expertise benefits all healthcare specialities such as Applied Behavior Analysis, Pediatric Billing Services, and Physical Therapy Billing Services in streamlining their authorization needs.
Simplify Your Prior Authorization Process Today!
FAQS
Frequently Ask Questions.
It’s a step where insurance companies verify treatments or prescriptions before approving coverage.
Top reasons include coding errors, incomplete information, and expired filing limits.
Through accurate eligibility verification, clean submissions, and routine assessments using denial tracking tools.
Normally, it takes 3 to 7 workdays, but with our streamlined process, fast help can get it done in less than 2 full days.
Yes, we can work independently on your software and integrate with all EHR systems like athena, ModMed, NextGen, and eClinical Works to update authorization notes and streamline the process.
Our team offers 24-hour capabilities with 100% backup, ensuring continuous support without interruptions from sick days or time off.
