Insurance Verification & Authorization Process



  • Insurance Verification & Authorization Process

  • We have a highly trained staff that performs eligibility verification of benefits in order to avoid delays or errors in insurance coverage. Then the team verifies coverage on any primary or secondary payers by utilizing payer websites, automated voice response systems, or by making phone calls to payers. We also offer real-time Pre-authorization services for walk-in patients.


  • Benefits

    • Reduce costly rejections and denials by checking eligibility before patients are seen.
    • Increase profitability – reduce costly write-offs.
    • Improve staff productivity – eliminate manual eligibility verification.
    • Increase cash collections – obtain up-to-date co-pay, co-insurance and deductible information.
    • Receive real-time access to critical patient and insurance information, including coverage dates, benefit information, co-pays and more.

  • Pre-Authorization/Pre-Certification:

    • As a medical billing professional, dealing with prior authorization is a necessary part of the job. Prior authorization (also known as Pre-authorization) is the process of getting an agreement from the payer to cover specific services before the service is performed. This scenario most often occurs in emergency situations, due to an accident or sudden illness that develops during the night or on weekends. When this happens, our team will contact the payer as soon as possible and secure the necessary authorizations.


  • Referrals:

    • Any denial due to no referral, our staff should first review the account to see if the referral/authorization was obtained and if it is present, if referral is not present we will verify with insurance PCP details and then try to contact PCP for referral info and then resubmit the claim. Our experienced team will work to resolve the claim by taking necessary steps for this denial.