pillsPrior authorizations (also known as prior approvals) are utilized by payers for the purpose of controlling costs and making sure members are only receiving care that’s medically necessary. Part of the process involves requiring providers to acquire advance approval from payers prior to delivering specific services or items to a patient.

As payers use prior authorizations in greater numbers as a means of lowering costs and boosting care quality, there are a few strategies that can be adopted to make the process easier and more automated with fewer hiccups along the way.

Authorization automation. Adopting automated prior approvals can help with reducing errors and streamlining the process, especially if you’re able to go fully electronic which saves money as well as valuable time. Electronic prior authorization (ePA) technology integrates with provider EHR systems to automate processes such as authorizing medications.

Pre-check for services and prescriptions. In many cases, providers must wait for payers to receive and approve prior approvals before a course of treatment can begin. Payers may deny medications or services, requiring providers to spend time submitting appeal documents. An effective way to deal with this is to devise a proactive strategy where care delays can be avoided. Before furnishing services or sending over prescription information to a pharmacy, authorization requirements should be checked.

This update is by Medical Accounts Systems, a full-service healthcare revenue cycle management company providing a number of services including insurance follow up and managed care disputes, physician reimbursement, extended business office services, and more. For additional information on our services or for any questions you may have on topics such as health insurance collections, please call 877-759-6315.