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Prior Authorization & Retro Authorization

What is Prior Authorization?

The pre-authorization process can be helpful to ensure the procedure’s covered by a patient’s insurance, but it can also take a frustratingly long period. Many doctors and administrative employees find that the long pre-authorization process lowers their productivity and turnaround times. Specific medical procedures must be approved or pre-certified before being performed for the insurance company to cover them.

Managing pre-authorization is really a time-consuming and challenging undertaking for busy practices. An enterprise like eMedRCM can provide insurance authorization services without consuming more time or resources. Our experienced staff offers effective pre-authorization services.

Why should you Outsource Prior Authorization Services?

Prior authorization is one of the most difficult tasks that a medical practice must take on. It’s a laborious, challenging, and expensive process because it consumes so much of your office’s time and resources. Because of this, many healthcare systems and hospitals decide to outsource the work to an experienced medical billing company.

Outsourcing prior authorizations to a company specializing in them can be an excellent way to save time and money. It also aids in providing patients with treatment or diagnostics as soon as possible.

When you use third-party company service for prior authorizations, it acts as a facilitator between your practice and the insurance companies. It obtains patient information to secure prior authorization for inpatient and outpatient procedures, as well as hospital admission pre-certifications. An advantage of using an outsourced prior authorization service is that they have created a centralized and simplified approach that reduces patient data inaccuracies.

Benefits of Outsourcing Insurance Prior Authorization Services

An outsourcing company will handle responsibilities such as:

  • The entire pre-authorization procedure

  • Obtain authorization from your insurance company for procedures and services that require prior approval.

  • Any monitoring, for example, if further information is required for pre-certification from the physician.

Advantages of Outsourcing Your Pre-Authorization Process to eMedRCM

Outsourcing comes with incredible advantages; it saves you time and money, eliminates much of the burden on your administrative team, and reduces the risk of a medical records review which has the potential to essentially halt your revenue stream.

If you are considering outsourcing your presets to a company with experienced prior authorization specialists, we encourage you to take a moment to better familiarize yourself with eMedRCM prior authorization services and how we can assist with your goals.

Suppose you are thinking about outsourcing your precepts to a prior authorization company with experienced professionals. In that case, we urge you to learn more about our medical billing and coding services and how we can help you achieve your goals.

  • We offer a whole prior authorization process from beginning to approval.

  • If a pre-authorization requires additional information, we will do our utmost to find or call the concerned doctor.

  • If a request is refused for pre-authorization, an appeal will be issued whenever possible.

  • Our safe and HIPAA-compliant site provides regular updates.

  • Our pre-authorization maintains their compliance up to date training.

  • A specialized pre-authorization staff means fewer cracks and a more streamlined billing system – meaning that your practice is better off.

Prior Authorization Services We Offer

Our pre-authorization services assist hospitals, outpatient institutions, and physician practices in the following ways:

  • The entire pre-authorization procedure

  • Obtain authorization from your insurance company for procedures and services that require prior approval.

  • Any monitoring, for example, if further information is required for pre-certification from the physician.

  • Requests for refusals if relevant.

We highly recommend you use quality control procedures, take prior authorizations and structure billing processes to ensure error-free billing.

Talk to us today to discuss your needs.​

We do more than just billing – We transform the revenue cycle with solutions that streamline the patient experience, drive operational efficiency and improve financial performance.