Authorization Delays
It can take several days or even weeks for health insurance companies to process requests, delaying patient treatment and payment.
Prior Authorization Services
Reduce Authorization Delays, Improve Approval Rates, and Accelerate Patient Care
Prior authorization management can delay patients’ access to health services, increase workload for hospital staff, and prolong reimbursement processes.
eClaim Solution’s prior authorization services will assist healthcare facilities in obtaining quick approvals, reducing rejections, and streamlining the overall authorization process.
Why Prior Authorization Matters for Healthcare Providers
It affects clinical service operations, patient satisfaction, and financial results. When the authorization process is handled poorly, organizations can face the following challenges;
Treatment delays
Claim denials
Revenue cycle disruptions
Delayed reimbursements
Increased accounts receivable
Administrative burden on staff
Patient dissatisfaction
Physician and staff burnout
A properly managed prior authorization process will help avoid such issues while improving care coordination and revenue integrity.
Financial Impact of Prior Authorization Delays
Poor authorization management affects more than administrative efficiency; it directly impacts financial performance. Common consequences include:
Delays in cash flow
Slow insurance authorization procedures hinder efficient cash flow and lead to delays in payments for providers.
Loss of reimbursements
Lack of or inaccuracy in authorization leads to loss of opportunities for getting claims back.
Increased claim denials
Nonexistent or delayed insurance authorizations result in high claim rejection percentages.
Low operational efficiency
Workflow suffers due to constant authorization issues.
Poor patient satisfaction
Authorizations being delayed negatively impact patient experience.
Increased staff overtime
It takes more effort from administrators to obtain approval and fix documents, hence directly affecting staff.
Rise in accounts receivable (AR)
Unprocessed or denied authorizations cause higher balances owed by patients.
Procedure postponement/cancellation
Providers have to either postpone or cancel procedures because of a lack of approvals.
Common Prior Authorization Challenges We Help Solve
Lack of Supporting Documents
The absence of relevant clinical records, test results, and other related documents causes either delay or rejection of authorization requests.
Expiring Authorization
Some authorizations may expire before patients undergo certain procedures.
Office Staffing Issues
Office employees might find it difficult to process authorization requests while scheduling other patients and managing other administrative functions.
Problems with Follow-Ups
Following up on a payer's response is time-consuming and takes much effort from office staff members.
Delays in Urgent Procedures
Some urgent procedures may get delayed due to difficulties with processing authorizations.
Our Prior Authorization Process
With our well-structured process, we achieve faster authorizations, resulting in fewer authorization-based denials.
01
Eligibility Verification
We check patient eligibility and insurance before submitting authorization requests.
02
Medical Necessity Review
We check payer guidelines to determine whether the patient meets medical necessity requirements.
03
Documentation Collection
We collect all necessary documents required for the authorization requests.
04
Authorization Request Submission
We submit authorization requests in accordance with payer policies.
05
Insurance Follow-Up
We follow up with insurers to know the application status of authorization requests.
06
Authorization Status Tracking
We track the status of approvals, pending requests, and authorization refusals to ensure a smooth medical billing process ahead.
States We Serve Across the United States
Medical Services Requiring Prior Authorization
The following are some of the medical services our department authorizes on behalf of providers and payers:
MRI services
CT scans
PET scans
Surgeries
Outpatient services
Behavioral healthcare
Physical therapy
Rehabilitation
Specialty drugs
Oncology
Infusion therapy
Sleep studies
Advanced diagnostics
Home healthcare
Durable Medical Equipment (DME)
We also cater to prior authorization for pharmaceuticals and high-cost services.
Insurance Plans & Payers We Work With
The following are insurance plans and payers that our company has been working with:
Medicare Prior Authorization
UnitedHealthcare
Aetna
Molina Healthcare
Medicaid Authorization
Cigna
Humana
TRICARE
Blue Cross Blue Shield (BCBS)
Regional and State-Specific Health Plans
We also cater to prior authorization for pharmaceuticals and high-cost services.
eClaim Solution’s Prior Authorization Services for Specialty Practices
Every specialty will require different authorization rules. This is something our specialists are aware of regarding the requirements of specific payers concerning complicated procedures and treatments.
Dialysis services, specialty treatments, and specialty medications.
Cardiac imaging, stress tests, catheterization, and specialty procedures.
Chemotherapy and radiation therapy treatments and specialty medications.
Rheumatology
Biologics, infusion therapy, and chronic disease management.
Joint replacements, injections, imaging, and rehabilitation services.
Pain Management
Specialty procedures, injections, and treatment programs.
Evaluations, mental health programs, and psychiatric treatment.
Neurology
Neurological tests and specialty medications.
Gastroenterology
Endoscopic procedures and specialty treatments.
Specialty imaging and procedures.
Why Should You the Outsource Prior Authorization Services?
There are various reasons why some organizations outsource their prior authorization services.
Prompt authorization approvals
Decreased workload of front office employees
Better document handling
Lower chances of authorization denials
Positive reimbursement results
Patient satisfaction
Operational efficiency
Ability to scale operations
Providers can focus on delivering healthcare services while our experts handle authorization issues.
Why Choose eClaim Solution to Optimize Prior Your Healthcare Revenue Cycle?
Insurance Eligibility Check in Real Time
We confirm patients’ insurance eligibility in real time before starting treatment. This prevents claim denials, removes any unpleasant surprises, and enables our healthcare partners to make informed decisions early on.
Prior Authorization Requesting and Monitoring
Our efficient submission process guarantees that prior authorization requests are submitted promptly and continuously monitored. By doing this, we ensure each request for prior authorization is monitored until final approval is achieved.
Procedure Scheduling Without Delays
As we minimize authorization process delays, we also help healthcare organizations minimize their procedure scheduling bottlenecks. Patients will receive treatment without experiencing unnecessary wait times due to the delay.
Prior Authorization Specialists Working With You
Our experienced specialists work with you on each prior authorization request. They know what information payers need, how to submit a request, and how to prevent denials.
Fast Approvals of High-Value Procedures
Our experience lies in the fast approval of costly or high-value treatments such as MRIs, CTs, surgeries, durable medical equipment, and medications requiring special prior authorizations.
Prevent Denials – End-to-End Workflow
We identify all possible problems with a request before it is submitted to the payer. Thus, we greatly increase the chances for a positive outcome and help avoid unnecessary delays.
Performance Metrics That Matter
2
%
Clean Claim Rate
2
%
Prior Authorization Approval Rate
<
2
Days AR Turnaround
2
%
Coding Accuracy
2
%
Eligibility Accuracy
2
%
Appeal Success Rate
Frequently Asked Questions
What is prior authorization in the healthcare industry?
Prior authorization is a procedure where insurers need authorizations from healthcare providers to provide particular types of treatments, medications, or procedures.
Why do insurance companies need prior authorizations?
Insurance companies utilize prior authorizations to assess the medical necessity of a particular treatment, manage costs, and determine if the proposed service meets certain criteria.
How long does prior authorization take?
The process depends on the service, type of insurer, and particular needs. The approval process can take up to 24-72 hours, depending on various factors.
What do I do if my request for prior authorization is denied?
Healthcare providers might have to supply more information or initiate a reconsideration or appeal process.
Is prior authorization subject to an appeals process?
Yes. Insurance companies provide appeals procedures for denied authorizations.
How much does prior authorization cost?
The amount varies according to several factors, such as the number of authorizations, specialty authorizations, payer complexity, and type of service.
What are the required documents for prior authorization?
Documents usually include medical records, physician orders, diagnoses, treatment plans, medical necessity, and patients’ insurance details.