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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.
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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.
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.
Specialties And Clients We Work With
We support a wide range of specialties like Pain Management, Podiatry, Orthopedic, Cardiology, OT/PT (Occupational and Physical Therapy), Speech Therapy, Mental Health, Dermatology, Rheumatology, Ophthalmology, and Endocrinology. Partnering with experienced professionals ensures faster approvals and helps practices focus on care delivery.
Clients Include:
- Healthcare Providers – Clinics and hospitals that require insurance approval support.
- Health Insurance Companies – Organizations managing intricate pre-authorization needs.
- Medical Billing & RCM Providers – Firms requiring seamless integration of prior authorizations with Revenue Cycle Management.
- Pharmacy Benefit Managers (PBMs) – Companies needing medication authorizations.
- Occupational Health Services – Supporting workplace medical needs.
- Telehealth Providers – Online service providers seeking quick treatment approvals.
- Research Institutions and Universities – Research Institutions and Universities need approvals to continue their medical studies and discoveries.
Common Prior Authorization Roadblocks and How to Overcome Them
Securing prior authorization (PA) approval can be a complex and time-consuming process. Below are some of the most frequent reasons for prior authorization denials and practical solutions to address them:
Common Prior Authorization Denial Reasons:
Cost-Effective Alternatives Preferred by Insurers:
Insurance payers often favor lower-cost treatments, such as generic medications, over brand-name drugs or more expensive procedures.- Insufficient Medical Necessity Documentation:
Prior authorization requests may be denied if they lack a clear explanation of why the treatment is medically necessary, including diagnosis codes and clinical justification. - Paperwork and Coding Errors:
Incomplete forms, typographical mistakes, and incorrect billing codes are common administrative errors that can trigger denials. - Coverage Exclusions and Benefit Limitations:
Certain treatments, such as elective cosmetic procedures, may not be covered under the patient’s health plan, leading to automatic denials. - Incomplete Clinical Information:
Requests that fail to provide sufficient clinical details regarding the treatment plan, patient history, or prior treatments are at high risk of denial. - Pre-authorization Timing Errors:
Performing tests or treatments before obtaining prior authorization can result in non-payment, as services must be approved in advance.
How to Accelerate Prior Authorization Approvals
- Submit Thorough and Accurate Documentation:
Ensure that every prior authorization request includes comprehensive details such as the patient’s medical history, diagnosis codes, clinical notes, and clear justification for the requested treatment. - Leverage Electronic Health Record (EHR) Systems:
Utilizing EHR-integrated prior authorization solutions streamlines the submission process, reduces manual errors, and speeds up communication with payers. - Maintain Transparent Patient Communication:
Inform patients about potential prior authorization requirements and possible delays. Keeping them informed helps manage expectations and reduces frustration. - Proactive Collaboration with Insurance Payers:
Establish open lines of communication with insurance companies to quickly resolve documentation issues, clarify requirements, and appeal denials effectively.
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.
What are outsourced prior authorization services?
Outsourced prior authorization services involve delegating the process of obtaining insurance approvals for treatments, procedures, and medications to a specialized third-party provider. This streamlines operations, reduces administrative burden, and speeds up approval times.
How does pre-authorization benefit healthcare providers?
Pre-authorization ensures that insurance will cover the cost of a service before it is performed. This minimizes claim denials, prevents revenue loss, reduces billing delays, and improves the overall patient experience by avoiding unexpected costs.
What is the difference between prior authorization and pre-authorization?
Why should my practice outsource prior authorization tasks?
Outsourcing prior authorization saves time, reduces administrative overhead by up to 50%, decreases denial rates, and speeds up approvals. It allows healthcare staff to focus on patient care while experts handle the complex authorization process efficiently.
Which insurance companies do you handle prior authorizations for?
MZ Billing manages prior authorizations for all major Government and Private insurances, including Medicare, Medicaid, Cigna, Humana, Aetna, Blue Cross Blue Shield, and more, following each payer’s unique protocols.
How does outsourcing prior authorizations improve approval turnaround times?
By using automation, real-time tracking, and payer portals, outsourced teams can reduce prior authorization approval times from over a week to as little as 2-3 days, improving patient care delivery and cash flow.
Can you integrate prior authorization services with my EHR system?
Yes, we integrate seamlessly with over 200 EHR systems, including athenahealth, eClinicalWorks, ModMed, and NextGen, ensuring a smooth workflow with no disruptions to your practice’s operations.
How do you handle denied prior authorization requests?
Our team manages the entire appeals process, including documentation corrections, peer-to-peer reviews, and proactive payer follow-ups, to recover payments and resolve issues quickly.
Is my practice’s patient data secure when outsourcing prior authorizations?
Absolutely. MZ Billing maintains strict HIPAA compliance and uses robust security protocols to protect patient data, ensuring full confidentiality and secure information handling.
How can I start using MZ Billing’s prior authorization services?
Getting started is simple. Fill out our contact form for a free consultation, and our team will reach out to customize a prior authorization solution that fits your practice’s needs.
