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Authorizations

Authorizations/Referrals

Pre-authorization, prior approval, or pre-certification, all of these terms mean the same thing – obtaining prior approval from an insurance (payer) before a doctor provides services to a patient.  This confirmation by the payer that a procedure, treatment plan, medical equipment, or prescription drug is medically necessary provides an authorization number that has to be included on the claim when submitted.

A referral, on the other hand, is when a primary care physician (PCP) recommends a patient to a specialist for consultation or healthcare services they are unable to provide. Many insurance companies require this step before agreeing to pay for a visit to a specialist. To file a successful claim, you have to make sure you have this referral on file for your patients.

These steps in the revenue cycle management are critical. Obtaining pre-authorizations or ensuring you have a referral can provide several advantages:

  • Accountability and cost containment
  • Reduction of denials and enhanced collections
  • Reduction in write-offs
  • Increase in revenue

The process for obtaining prior authorizations and referrals can be done in many ways such as:

  • Phone calls
  • Online forms
  • Faxes sent through PMS

All of these take time and add an administrative burden on your staff! Time that could be better spent ensuring the quality of patient care is delivered and maximized. Also, your staff needs to be aware of a variety of different payer’s guidelines, which continually change. Staying ahead of all of these changes is time-consuming as well.

Billed Right helps save you time and reduce your denials!

Understanding all of the ins and outs of obtaining pre-authorizations and referrals is important in avoiding lost revenue and negatively impacting your practice financially. Billed Right has the expertise to help you manage what can sometimes be a very complex process.

To learn more about how Billed Right can help you with authorizations and referrals contact us today!

Outsourcing Prior-Authorization/Referrals is the Best Option

At Billed Right our Authorizations and Referral Services in Florida provides doctors with the additional resources to obtain necessary pre-authorizations/referrals and ensure claims are submitted with the required information for each payer, thus offering a more optimized workflow saving you time and money.

With our authorization/referral service you can expect:

  • A virtual prior authorization resource
  • Submission of request within 12-24 hours
  • Track record of the authorization and referral steps completed
  • Notification if a peer-to-peer review is requested
  • Work done through Practice Management System
  • Communication with staff on approvals and denials of auth and referrals