There are 5 steps to prior authorization when looking at it from a best practice standpoint. These steps include demographics, eligibility, determination, submission, and status retrieval. Tune into this podcast as Paul and Blair dive deeper into each of these steps and discuss patient involvement in the process. This episode is sponsored by AccuReg.
Summary
Streamlining the Prior Authorization Process: 5 Steps to Follow
Prior authorization can be a complex process, but following the best practices can help make it easier for everyone involved. In this podcast, Paul Sero and Blair Baker from AccuReg discuss the five steps to prior authorization and provide tips on how to involve patients to improve the process.
Step 1: Demographics Check
The first step to prior authorization is to check the patient's demographics, including their name, date of birth, and insurance information. This step helps ensure that the correct patient is receiving the proper services.
Step 2: Eligibility & Benefit Check
After confirming the patient's demographics, healthcare providers should check the patient's insurance eligibility and benefits. This step helps ensure that the patient's insurance covers the services they need.
Step 3: Determination
Next, healthcare providers must determine whether the requested services are medically necessary. This step is essential to ensure that the patient receives the appropriate care and that the payer approves the requested services.
Step 4: Submission & Status Retrieval
Once the determination is complete, healthcare providers must submit the required information to the payer. Many payers now offer portals for electronic submission and retrieval of the status of the prior authorization. It is essential to monitor the status of the prior authorization request to minimize delays in patient care.
Involving Patients in the Process
Patients can also be involved in the prior authorization process to ensure that it moves quickly. Healthcare providers can educate patients on the process, notify them when the prior authorization is approved, and explain what happens in case of a denial. By involving patients in the process, healthcare providers can improve patient satisfaction and reduce access delays.
Prior authorizations have been an administrative burden for healthcare providers, but new technology is making the process much more automated and efficient. Automation not only reduces administrative burden and cost, but it also helps reduce access delays for patients and improves staff retention. Ultimately, streamlining the authorization process improves net revenue by reducing or preventing patient access denials and improving patient outcomes.
If you are interested in collaborating with AccuReg on streamlining the prior authorization process, Blair and Paul would be happy to discuss how technology can help improve the process.
This episode is sponsored by AccuReg.
Note: This is an AI generated transcript, not edited by a staff writer and is solely intended for educational purposes. If you have any questions/concerns, reach out to podcasts@beckershealthcare.com
This episode aired on 12/01/2022 and can be listened here.
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