Comprehensive Review
Ensuring thorough assessment of retro authorization requirements.
Efficiency
Seamless Authorization Services
How Can We Simplify Your
Authorization Process?
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Our Services Today!
From pre-authorization to retro authorization, Velan Healthcare offers seamless solutions tailored to your needs. Our services include thorough eligibility checks, timely submissions, and diligent follow-ups to ensure swift approvals. Experience hassle-free authorization with us!
Authorization
Pre & Retro Authorization Billing Services How Can We Optimize Your Medical Billing Process? Explore Our Prior & Retro Authorization Services Today!
Pre and Retro authorization billing service in the USA is essential to avoid insurance denials for high-value procedures. Without it, claims may go unpaid. At Velan Healthcare, we take on the pre and retro authorization process for you, submitting records and securing approval 2 days in advance. Our system offers transparent updates on all pre-authorizations we handle, easing the burden on your practice.
Identification of Need
A healthcare provider identifies the requirement for a specific procedure, test, prescriptions, or device for a patient.
Policy Check
The provider checks the health plan's policy rules or formulary to see if prior authorization is required for the prescribed treatment. If needed, they fill out and sign a prior authorization request form.
Manual Review
Due to limited integration, provider staff manually reviews prior authorization rules, often found in various formats like paper, PDFs, or payer portals, specific to the patient's insurance plan.
Non-Standardized Rules
Rules for prior authorization vary between health plans and even within plans of the same payer. These rules change frequently, leading to potential confusion and outdated references for administrative staff.
Submission Process
If no prior authorization is needed, the claim is submitted to the payer, but this submission does not guarantee approval. If prior authorization is required, the provider must gather specific details for each relevant CPT code and obtain a unique payer-assigned number for the request.
Follow-up & Resolution
The provider then engages in manual follow-ups with the insurance company until a resolution—approval, redirection, or denial—is obtained.
Significance
Why Pre & Retro Authorization? Why Opt For Pre & Retro Authorization? Unlock The Significance Now!
Our goal is to simplify this intricate process into a smooth, efficient pathway, elevating patient care and maximizing financial outcomes.
Financial Security
Pre-authorization offers patients clarity on their insurance coverage and potential out-of-pocket costs, leading to fewer financial problems and fostering transparency in healthcare expenses.
Efficiency Boost
Healthcare providers benefit from pre-authorization by streamlining their processes. With approvals in place beforehand, they can deliver services promptly, avoiding treatment delays and easing administrative burdens.
Mitigated Reimbursement Challenges
Pre-authorization significantly lowers the chances of denied claims or reimbursement issues. Since procedures or treatments have already obtained approval from the insurance company, the risk of payment disputes is reduced.
Unlock the Significance of Pre and Retro Authorization How Can We Help You Minimize Denials and Expedite Access to Care?
Streamlining
How Does Our Insurance Approval Process Work? Are We Facilitating Timely Care Delivery Through Efficient Processing?
Detailed Policy Analysis
Thorough examination of policies and payers for accurate coverage assessment.
Rapid Authorization Needs Determination
Quick identification of prior authorization needs per patient
for seamless care.
Meticulous Paperwork & Timely Submissions
Preparation of precise documentation and prompt
submission to payers.
Persistent Follow-Ups
Vigilant tracking of requests, managing the
process proactively to completion.
Immediate Notification
Promptly informing providers of any authorization issues
or ambiguities.
Clarity & Education
Providing clear insights into coverage options for
informed decision-making.
Alignment with Coverage
Expertise in selecting treatment alternatives
aligned with patient insurance coverage.
Denial Avoidance
Rigorous process to significantly reduce denials
related to coverage issues.
Our speciality
Our work for you Authorization Service We Offers
Services Requiring Prior Authorization
- Diagnostic Imaging (MRI, CT, PET Scans).
- Durable Medical Equipment (Wheelchairs).
- Rehabilitation (Physical Or Occupational Therapy).
- Home Health Services (Nurses).
- Non-Emergency Surgery (Elective Procedures).
Medications That Often Require Prior Authorization
- Drugs With Serious Risks
(Like Severe Side Effects). - Tablets With A High Risk For
Misuse Or Addiction. - Drugs Used For Cosmetic,
Not Medical, Purposes. - Expensive Medications.
Our Speciality Authorization Billing
- Pain Management.
- Orthopaedic.
- Cardiology.
- Endocrinology.
- Rheumatology
Practices
How Can You Transform Your Financial Success? Are We Maximizing Retro Authorization Billing Service in Medical Billing?
Certifications
Compliance & Accreditation Are We Compliant? Learn How We Ensure Adherence to Regulations for Pre/Retro Authorization Billing.
How Can Our Pre/Retro Authorization Billing Services Transform Your Practice?