Overview

Clinical authorization is a requirement from health insurance companies to ensure procedures and treatments are medically necessary, and healthcare organizations are facing significant administrative and clinical challenges to obtain prior authorization from payers for inpatient and outpatient services. Services that require clinical authorizations include:

  • Elective surgeries (non-emergency)
  • Oncology (chemotherapy) services
  • Infusions and other therapies
  • Experimental and investigational services
  • High-cost drugs and devices

We help you secure clinical authorizations for complex medical cases, including prior authorizations (prospective) and concurrent authorizations, to ensure proper reimbursement and timely delivery of care aligned to payer contracts. Sharing clinical information to support the medical necessity required to obtain authorizations is an imperative part of the process to mitigate denials.

Clinical Prior Authorization Services
Clinical Prior Authorization Services Provider

SERVICES PROVIDED

  • Eliminating backlogs of pending authorizations
  • Monitoring communication between providers and payers
  • Concurrent authorization
  • Providing necessary medical codes
  • Faxing services
  • Peer to peer review

BENEFITS

Streamline processes to close communication gaps between providers and payers to maximize revenue cycle efficiency for accurate reimbursement.

Reduce errors that can lead to denials and resubmissions, minimizing the financial strain caused by denied claims.

Ensure services are aligned with payer contracts to ensure patients receive necessary treatments and optimized care plans without unnecessary delays.

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Clinical Documentation Integrity Services Thumbnail

A combination of retrospective, prospective, and concurrent reviews of clinical documentation provides precision and specificity in clinical documentation tailored to inpatient and ambulatory settings.

Utilization Management Services

Provide appropriate, efficient, and cost-effective care consistent with current medical standards, preventing unnecessary procedures and optimizing treatment plans to enhance patient outcomes, streamline resource utilization, and drive healthcare excellence.

Clinical Denials And Appeals

Review denied claims to identify root causes, and craft compelling appeals supported by comprehensive clinical evidence to maximize revenue and minimize financial losses.

Physician Advisory Services

Skilled physicians and healthcare professionals provide customized solutions to optimize clinical documentation, coding accuracy, and revenue integrity.

Resources

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