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Pre-Authorization / Pre-Certification Services

Have you come across situations where some of your claims have been denied by payers for lack of pre-authorization? If yes, you can greatly benefit by Vision’s Pre-authorization services.

As you must be aware, a no. of Payers need prior approval or pre-certification of certain procedure or services before they are provided to a patient. In case these services are provided without seeking their prior approval, they will deny the claim and it will result in Financial loss to the Provider. Therefore, the front office staff of a practice has to be alert and knowledgeable about the procedures requiring precertification so that they schedule a patient visit only after the requisite prior approval is in place.

Which procedures need pre-certification varies from payer to payer as well patient’s plan. With the everchanging Payer policies, managing pre-certifications becomes a very daunting task for the front office taking their focus away from the most important task of patient care.

Vision offers an efficient and cost effective Pre-authorization service for your practice.

Our experienced and knowledgeable pre-auth experts take care of the following tasks on your behalf:

  • Review each case to determine if pre-certification is required by the patient’s Insurance company for the planned service
  • Collect the Required Information: Complete Patient Demographics and Insurance Information, Referring Doctor Details and Referral Note from the Referring Doctor giving details of the Procedure to be performed as well as the medical necessity for the procedure
  • Apply for Authorization / Pre-Certification for required Procedures to the Payers
  • Answer queries / submit additional information sought by the Payers
  • Update the Authorization no. received in the Practice Management Software
  • Maintain a record of the Authorizations received
  • Submit a Monthly Report for all the cases handled along with the result
  • Give reasons where authorization not received

Benefit to Provider:

  • Minimum time lag in obtaining authorization
  • No loss of revenue due to claims denied for lack of authorization
  • Patient- centric approach
  • Specialised manpower dedicated to this task
  • Reduces your front office staff’s headache who can focus on patient care
  • All this at 30-40% lower costs