Payer pre-approval authorization requires a thorough process.
Several things can go wrong with ASC upfront collections. You want to be sure that your center will be compensated correctly for all the services provided. Be mindful of the following steps when obtaining payer pre-approval authorization.
Collect All Patient Information
The first step in this process should always be to collect all necessary information and ensure that it is accurate. This includes information such as a patient’s full name, date of birth, social security number, home address, carrier identification number, group/contract/plan number, date/name of the scheduled procedure, diagnosis, and name of the provider or surgeon, etc.
Contact The Payer
It is necessary to get in touch with the payer before the procedure to verify the all of the benefits. This may be an employer, an adjuster, or an assurance company, Since there are cases where benefits can change, you don’t want to contact them prior to 14 days. However, it needs to be done at least two days before. Also, benefits need to be verified for all add-on patients that are scheduled for the day of the procedure, and patients with secondary coverage need to be verified as well.
Obtain and Verify Information With Payer
This can either be done over the phone or online. This is going to differ depending on if it is for commercial insurance, Medicare or state program, or for workers’ compensation. You will need to ensure pieces of information like the name of the insured, the patient’s date of birth, social security number, effective date or date of termination, amount of coverage, exclusions to policy, date verified, etc.
May Need To Contact Business Office Administrator
It is possible that you may need to get in touch with the administrator or manager if you experience any significant problems. This would include if you determine that a patient is ineligible for coverage or any deviation of coverage.
Consult Patient Financial Counselor
In some cases, patients need to be compensated because of situations like deductibles and copays. Any and all information needs to be provided to patients financial counselors after the preauthorization is completed. This need to be done prior any procedure; however, it is important to note that preauthorization does not serve as a guarantee of payment. Also, it is essential to be mindful that requirements frequently vary from one payer to another. For this reason, all information needs always to be verified.
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