Understanding Prior Authorization Policies: Avoiding Delays and Denials
Introduction
Prior authorization (PA) policies require providers to obtain approval from payers before delivering certain services or procedures. Failure to comply can lead to claim denials and delayed payments.
What Requires Prior Authorization?
- High-cost procedures
- Certain diagnostic tests
- Durable medical equipment
- Specialty medications
Challenges with PA
- Time-consuming paperwork
- Variability in payer requirements
- Delays impacting patient care and revenue cycle
Best Practices
- Implement real-time PA verification tools
- Train staff on payer-specific PA processes
- Maintain a database of PA requirements by payer
MediCloud’s Support
Our team manages PA requests efficiently, reducing administrative burden and minimizing denials.
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Understand the billing and coding process through our comprehensive articles that offer insightful tips and tricks.