Prior Authorization Services
Highly accurate and efficient Prior Authorization Services
To avail a medical service or fill a prescription, approval from the health plan is needed in order to have them covered. This is known as prior authorization. Managing prior authorization is a frustratingly time-consuming process for busy practices. From filling out lengthy forms and keeping track of dates to waiting for approvals and negotiating with payers, things can be tough. Partnering with Scribe4Me eliminates the administrative burden while ensuring quick prior authorization approvals and hassle-free claims settlement on the first go.
Prior authorization services offered at Scribe4Me
As a first step we undertake to identify the root cause and determine the reason for the denial. When the insurance provider denies a claim they indicate the reason referred to as Claim Adjustment Reason Codes (CARC). Unfortunately, interpreting these codes takes time and requires expertise, since some insurance providers continue to use the overly complex, legacy codes. But our dedicated denial management professionals can easily handle these codes and identify why a claim was denied and who is responsible for its reimbursement.
Our prior authorization specialists thoroughly check the patient’s insurance details to find out if the medical service or medication is covered under their plan in order to get the prior authorization request approved. This verification step significantly reduces the chances of errors and denials.
To make the prior authorization process smooth and hassle-free, we undertake to maintain a thorough documentation and record of all pertinent information. For this purpose we have developed a standardized template which not only speeds up the prior authorization process but also reduces duplicate documents and human errors.
Our team is well-versed in all aspects of verifying insurance eligibility and benefits to help patients get prior authorizations from insurance companies. This ensures claim settlement on the first go. We don’t rely on insurance companies to communicate approved authorizations, but we follow-up with them to know the status and avoid delays.
Our coders assign the right ICD 10 diagnostic codes for prior authorization requests to facilitate quick processing of claims and prevent denials. Our experienced certified coders are well versed in the coding guidelines and industry best practices to ensure accurate and reliable coding.
As the prior authorization process is mostly manual, there are high chances that a request could be lost in one of the many steps. We keep track of prior authorization requests and regularly follow-up to prevent delays that may arise from information lost or not received by payers. This avoids communication gaps between providers and payers, resulting in quick prior authorization approvals and hassle-free claims settlement.
Service Highlights
Benefits
Revenue Cycle Management
Are you a healthcare provider under increased pressure to focus on providing care as well as maintaining financial viability? Do you feel overwhelmed with administrative and financial responsibilities? Feel like you are losing pace on follow-ups for efficient collection? Are you short of trained experts to handle the complex maze of RCM? Scribe4Me is here to help you.
Insurance Eligibility Verification
The first and most important step is to determine the patient's eligibility and insurance coverage. People often tend to forget to renew their health insurance policy annually. And insurance companies are in no way responsible for payments covered under the plan during the period of lapse. As a result the patient has to pay for the services out of his own pocket. What if the patient is reluctant to pay the bills?
Medical Coding
Medical Coding quality holds the key to accurate reimbursements. Scribe4Me has perfected the art of creating accurate and clean claims on the first go. We have a team of AAPC certified, trained medical coders who are proficient in coding rules and can provide accurate and complete coding necessary to optimize reimbursements.
Charge Entry Services
Accurate charges are crucial for claims to pass through the first time and Scribe4Me does it right, each time.It has been stated by insurance companies that 4 out of 10 claim denials are due to clerical errors. Charge Entry is a process of entering medical data to enable claims processing. At Scribe4Me we follow a well-structured Charge Entry Process and ensure that relevant checks are made at each level of the process.
Claims Transmission
Scribe4Me undertakes to do an EDI set-up for those medical practices that wish to get-off paper transaction claims and switch to electronic data interchange (EDI) for claim submission. Submission of the claims through EDI reduces the chances of inaccuracies and errors. Your claims will reach the payer instantly resulting in quicker reimbursements and eliminating claim processing delays.
Payment Posting
We believe that accurate charges contribute to attaining clean submission goals. Scribe4Me offers fast and accurate Payment Posting solutions as a part of the Revenue Cycle Management services and also as a standalone service depending on the client's requirements. Our team of experts has extensive experience in several specialties and in handling a wide range of medical software.
Accounts Receivable Management
We at Scribe4Me understand that Accounts Receivable is an important part of cash flow and requires rigorous follow up. That is why we have a streamlined system in place to control and manage your practice's accounts receivable and recovery. Simply trust the experts for efficiency, and we assure you that all the medical services provided by you will be paid for, fully and promptly.
Denial Management
Scribe4Me helps recoup revenue and maximize reimbursements Denial of medical claims is one of the major issues faced by physicians. Scribe4Me's Denial Management service is designed to perform a root-cause analysis, identify the reason for the denial and take action to resolve it. Most importantly we implement process improvements to stop recurring denials in its tracks.
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