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3 Ways to Improve Prior Authorization Services for Your Practice

Prior Authorization is one of the most important steps in healthcare processing. This makes it possible for the healthcare program to decide if the service satisfies the criteria for medical necessity and whether it qualifies for reimbursement. The payers themselves developed the guidelines for this and are based on medical criteria, costs, utilization, and other information.

Having said that, pre authorization services is a very time-consuming process and if not done properly, practices might not receive the reimbursements for the services delivered. Conventional systems for health insurance prior authorization on the other hand makes this even harder as it includes several papers works and a number of back-and-forth follow-ups with the payor.

Now that we are in this digital era, we have quite a lot of options to explore and implement. Keeping the flaws, the conventional systems set forth, the new solutions could rectify those and make the entire process easy to access, process, and get quickly reimbursed.

Let us now look into the top 3 ways that Practolytics could help you and your practice gain efficiency in prior authorization services and ultimately receive the reimbursements for the services rendered.

1. Electronic PA system

Despite the fact that Prior Authorization is a necessary step in many practices. The existing system is frequently manual and includes practitioners, insurers, pharmacists, and patients in a tedious information flow, which could cause treatment delays and annoyance for everyone.

In order to deal with frequent issues with the PA process, companies are using electronic prior authorization solutions or EPAs. Healthcare practitioners can quickly get prior authorization services in real-time at the time-of-service delivery, thanks to the seamless integration of Electronic Prior Authorization with Electronic Health Records (EHRs). This also gets rid of time-consuming phone calls, faxes, and paper forms.

When claims are rejected, prior authorization was neither obtained nor handled improperly in most of the cases. Hospitals can start automated pre authorization services using electronic PA software, which effectively reduces front-end rejections and denials.

Healthcare also found that saving up to 416 hours a year might be achieved with electronic prior authorization services! In 2015, the estimated price to a practitioner for a prior authorization that was wholly electronic was $1.89 as opposed to $7.50 for an authorization that was completely manual.

Practolytics will automate prior authorization services. Well, Practolytics is all set to help you with that. Leveraging your existing EMR system, AdvancedMD can provide a platform for your PA workflow, e-consultation, predictive modeling, a directory of patients and providers, and pre authorization services.

2. Be thorough with the insurance company’s policies and guidelines

Prior to rendering assistance or submitting prescriptions to the drugstore, Practolytics will review prior authorization regulations in order to minimize patient delays. The two services that insurers commonly demand health insurance prior authorization for are brand medications and imaging services like computerized tomography (CT) scans and magnetic resonance imaging (MRI).

Practolytics should therefore be acquainted with insurance regulations and create a list of medications for common disorders that are covered by all of them.

3. Adopt a centralized system

By consolidating the prior authorization responsibilities, procedures can frequently achieve improved efficiencies. Presently, most practices and healthcare systems lack the necessary time or do not possess duties that are clearly outlined while addressing the PA services.

Prior authorization services for the entire practice can be handled just by one or two people or a department, allowing those staff members to become experts in the procedure and forge connections with payers. A centralized method guarantees a more dependable and steady approach while addressing the issue of inconsistency.

Bonus Tip

Now that you know the ways that could make your health insurance prior authorization process easier, it’s time for you to understand that despite employing all these in your practice, Pre authorization services could get hard for you to handle as medical professionals. It’s not just about making the process easier, it’s also about managing the process while you have so much on your plate already.

As a healthcare professional, your focus should only be on patient care and making it better every day. So, it is always better to look out for a partner who could help you eliminate the additional stress. Practolytics offer health insurance prior authorization services to our clients so that, they can focus on their priorities.

We make their lives easier by guiding them through the whole process and delivering pre authorization services through expert hands. AdvancedMD and Practolytics come together as a power combo to make it true and allow you to become more efficient in your duties.

Reach out to us to learn more about us!


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