Prior Authorization Services

For doctors and other medical professionals to be eligible for payment coverage from a health plan, they are required to obtain approval in advance from the health plan in the form of prior authorization, which is also known as pre-certification or prior approval. Health plans use the prior authorization process as a cost-control measure.

Pre-authorization from the insurance company is required for several treatments. We must be mindful to check whether services need prior authorization when determining insurance eligibility. The patient’s insurance plan forms the basis of the approval. Insurance companies pre-authorize requests in accordance with the benefit conditions and necessary medical procedures. The insurance company issues a pre-authorization number, which must be referenced in the final claim form that is submitted after the treatment is finished.

Impact Of The Authorization

  • It’s likely that the insurance company will ask for authorization before paying for services provided by an out-of-network provider rather than an in-network one.
  • It is required by law to make sure that the insurance provider covers the particular medical service listed on the medical claim form. The insurance payer is free to decline payment of a patient’s medical service under the terms of the health insurance plan without authorization.

The MSAI team can assist you in obtaining the authorizations with the aid of our benefits team since the impact on the claim is 100% if the authorization is not accepted. If a service needs authorization, our team will check with the insurance company to see if it does or not. Once approved by our team, we will proceed with the following procedures to submit the authorization request to the insurance company.

Submission Process

Technically speaking, the websites of insurance companies are expanding themselves. On their websites, we do have the ability to submit the authorization. Forms for offline and online submission of authorization requests are available.

There are chances that the payer may request additional documentation based on their requirement.

Preventing The Authorization Denial From The Payers

  • Early Submission of Authorization Request
    Before receiving therapy, authorisation requests must be submitted. Getting the authorisation number to determine payment is aided by early submission.
  • Double Check Codes
    We must ensure that we are referring to the appropriate CPT, HCPCS, and DX codes provided by the coders when submitting permission requests.

Reach MSAI to know more about the Authorization Services

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