Faster Approvals. Fewer Delays. Better Patient Care.
Practolytics’ Virtual Prior Authorization Services help healthcare practices manage the authorization process from eligibility and documentation to submission, follow-up, and status tracking. Our experienced teams help reduce administrative delays, improve approval rates, and ensure patients receive timely access to care.
Virtual Prior Authorization Services for Faster Approvals and Fewer Denials
Doctors and hospitals typically need prior authorization from an insurance company to complete certain procedures, tests, medications, or other services. This can be a highly involved task. You must know which of your treatments require authorization, gather evidence to support your request, send it off, and follow up with the insurance company.
Virtual Prior Authorization Services by Practolytics offer remote administration help. You can agree on what tasks you want carried out by a remote team that will work according to your pre-authorization process.
This aims to bring structure to the authorization process and eliminate unnecessary delays. However, there will still be a final check by the paying party, and no service can guarantee that they will be approved for all requests.
Depending on the level of service we offer
- Checking pre-authorization criteria for the particular payer.
- Checking eligibility and insurance details for the patient.
- Gather clinical information from an approved source.
- Submit pre-authorizations.
- Monitoring and tracking requests and responses.
- Following up on incomplete information or delays.
- Note authorizations and numbers.
What Are Virtual Prior Authorization Services?
Virtual pre-authorization services provide remote support to complete certain administrative tasks to gain approval from health insurance companies. A virtual team will complete these tasks using approved EHR applications, payer portals, and communication systems on your behalf.
These services can be useful when internal staff lack enough time to manage and deal with the complexities of getting authorizations from various payers and specialties. This can be managed by a support team that won’t make any clinical decisions.
Outsourcing virtual prior authorization services can be offered as a stand-alone service or as an additional resource. It needs to be clear what will happen to complex clinical questions, incomplete documentation, peer-to-peer requests, and urgent cases.
Examples include
- Identification of any service, process, test, or medicine that may require pre-authorization.
- Gathering and recording of relevant clinical information and evidence from authorized clinical staff.
- Complete required fields and make requests to the relevant payer.
- Monitor status: Keep an eye on requests that are ‘To Do,' 'Approved,' 'Denied,' or 'Incomplete.'
- Contact payers: Contact payers or portals for additional information.
- Maintain an up-to-date record within the agreed system.
How Our Virtual Prior Authorization Process Works
By incorporating a structured process into your workflow, you will reduce the risk of missing requests and can also identify any bottlenecks. We can work with you to review your current process and discuss how we can support your practice with remote authorization support.
A standard process can consist of:
Initial assessment
Consider what specialty you’re offering and what payers you work with. What are your current issues?
Requirement Check
Use available sources to find out what requirements the payer has for this service.
Data Collection
Work with authorized individuals to collect information about the patient and clinical evidence.
Complete Request Form
Make sure to complete the request form with the relevant data.
Submit Request
Submit the request via the agreed method. Monitor the status of your request.
Follow Up with Payer
Follow up to ensure any outstanding requests, missing information, or additional requirements are completed.
Record Decision
Record the decision made by the payer. This should include the authorization number, service approved, and dates.
This workflow provides support for virtual prior authorization for medical practices. This enables medical practices to manage their prior authorizations while keeping patient clinical documentation and medical necessity decisions in the hands of the treating provider.
Why Practices Outsource Prior Authorization
Prior authorization can result in a lot of administration. With multiple insurance companies to work with, there are often different rules for each type of service and each plan the patient has. This can be difficult for in-house teams to manage along with the other tasks they have, such as appointments, queries, and general administration.
This can cause a practice to look into outsourcing to give them extra capacity.
Using a virtual prior authorization service for healthcare providers can help alleviate the additional workload in your practice without the requirement to take on additional permanent staff. It is important to have clear processes in place for communicating, keeping secure, and escalating issues, plus having good continuity of contact with the practice.
Common reasons are
- A lack of resources can cause issues with existing staff being able to manage the volume of authorizations.
- A large volume of requests can cause issues in specialist practices with a large volume of requests for procedures, imaging, medication, and treatments.
- Backlog of requests: Remote assistance can help manage backlogged requests.
- Multiple payer workflows: Helps your team stay on top of each payer’s submission requirements.
- Administrative Continuity: Helps you keep a handle on your requests if your workload changes internally.
Why Choose Practolytics?
Selecting a provider may seem a simple process based on cost, but it is important to select a team that understands the requirements of providing accurate information, dealing with individual payers, and fast turnaround times.
We can discuss how we can provide the correct amount of support to fit with your current process, volumes of authorizations, and administration requirements.
Things to consider:
Define the level of support, such as requirement checking, documentation collection and submission, and chasing and coordinating denials.
Know how they will integrate into your existing team and systems.
How will they escalate urgent requests, incomplete documentation, and clinical questions?
Visibility: An agreed process on how to record open cases, fulfilled requests, and payer decisions.
Flexibility: Resources and support reviewed based on the number of requests.
Ask these questions: Do you have dedicated virtual prior authorization providers to handle this service, or do you assign this task to your general admin? How do you train your staff? What specializations do you have? What backup do you have in place? How do you manage complex cases?
Prior Authorization Support by Specialty
Depending on the specialty you work within, different information might be required to be provided to gain approval for a patient for an advanced imaging study. You should ensure your remote support is specific to what information is required in order to meet the criteria and payer requirements.
Virtual prior auth services for clinics can be helpful in a clinic setting when you frequently need to manage prior authorizations for:
Ask your virtual prior authorization services for healthcare providers: how much of a fit they will be with your services and payers. Find out if they can support your specialties, what documentation they require, what payers they support, and how they will manage authorizations for medications and medical services.
Conclusion
Using prior authorization support can take a lot of hassle off your plate when it comes to dealing with payers. And it makes it easier for you to submit requests, track decisions, and follow up on pending approvals. But you have to make sure you’re using a remote support system that matches your area of expertise, systems, payers, and practice.
Before you hand things off, figure out the basics: Who’s handling which tasks? What happens when something gets stuck? What kind of reports will you get? How is data kept secure? And, of course, how much are you paying for all this?
If you want, we can sit down and look at how you’re managing authorizations right now. We’ll talk about where remote support can make things easier. With a tighter system, your admin staff isn’t drowning in paperwork, and your clinical team can stay focused on patient care and medical decisions. That’s the goal.
Virtual Prior Authorization Services FAQs
1. How fast will I get prior authorization approvals?
Approval times can vary depending on who you are paying, what service you are requesting, the quality of your request, and whether we need any additional information. We can support you with creating requests and chasing any outstanding cases. The final decision and time to approval will be at the discretion of the payer.
2. How much do virtual prior authorization services cost?
Prices will depend on the number of requests, your specialism, how much they can do for you, and how many hours they will work for you. Some providers may charge an hourly, monthly, per-request, or bespoke rate. Ask them for a written quote outlining any setup costs, what is included, and any additional costs.
3. Which specialties and payers do you support?
Confirm specialty and payer. Tell them what your most common procedures, medications, insurance plans, and authorizations are. This will help give them an idea of how they can support your workflows.
4. Can you work inside my EHR or practice management system?
Depending on your level of access, support can be provided remotely using your existing EHR/practice management system, as long as you have access to the right systems, users, and any required integrations.
5. Is it HIPAA compliant and secure?
Any service handling protected health information must adhere to the appropriate privacy and security requirements under HIPAA. You should ensure that employees are adequately trained, there is an appropriate level of access, communications are secure, there is appropriate monitoring, and there are any business associate agreements.
6. What happens if a prior authorization is denied?
This team will be able to explain why the application was rejected and what information is missing. Where required, they can work with you to agree on what should happen next. The amount of support that will be available will depend upon what was agreed upon at setup. They can help to prepare additional documentation or organize an appeal. However, clinical reasoning and decisions at the provider level should come from the treating clinician.
7. How is this different from prior authorization software?
Prior authorizations make it easy to validate your requirements, build your application, provide information, and track your application. Virtual services can be used to have staff handle agreed administration tasks remotely. A number of solutions offer a hybrid solution of both software and staff support.
8. How do I get started, and how will I measure results?
Ensure current processes are in place to authorize requests, including volume, specialties, and payers/systems. Ensure agreed roles, access, reporting processes, and escalation processes. Metrics could look at volumes submitted, time to submit, % of follow-up completed, denial trends, and turnaround times (with consideration of payer delays).
Faster Approvals. Fewer Delays. Better Patient Care.
Simplify Prior Authorizations and Keep Care Moving. Connect with Practolytics to get started.