Prior authorization is a process of obtaining advance approval from health plans. Obtaining PA is a lengthy process that requires never-ending paperwork and frequent phone calls that delay patients from getting vital care on time. A recent AMA study shows that the issues providers face have increased in the last five years.
Prior authorizations may be required for procedures, treatment plans, and certain prescriptions.
General points to consider while obtaining prior authorization are:
1) Bill correct CPT codes
2) Follow payer criteria
3) Follow approved care specifications
4) Revise insurance contracts regularly
5) Refer carrier websites
Preparing health plan wise & procedure wise templates will make the pre-certification process easier and manageable.
Glenwood now offers a standardized pre-authorization service as an add-on service for its GlacePremium customers. Glenwood will also be releasing integration with SureScripts electronic prior authorization (EPA) beginning Q4 2021.
Refer AMA resource link here to learn more about the reform initiatives and access the survey stats and reports.