Another greatest contributor to lost revenue is the failure to obtain a referral or
authorization
before performing a procedure. The most common denial in medical billing reimbursement rates is
Pre-Authorization, Prior Authorization, Pre-Certification, and Notification. Not all services and
procedures require a referral or pre-authorization. However, if a referral or pre-authorization is
required and is not obtained, reimbursement for the procedure is put at risk.
Authorization is getting a medical service(s) authorized by the insurance carrier.
Providers or Medical billing companies must
contact insurers in advance and obtain a certification
number to be reimbursed properly. These processes result in an authorization and referral number
that providers/billing companies must use on claims submitted for payment.
Scribe Align is well aware of the Authorization and Referral process. We consider and
manage it as a special project in Medical Billing Cycle because of the time and costs associated
with it. Our Authorization Specialists have wide-range knowledge of functionalities and compliance
with payer contractual requirements. We identify, verify eligibility, obtain insurance benefits, and
ensure pre-certification, authorization, and referral requirements through all paperwork and
research relevant to each case from the payers.
We Obtained prior authorizations and referrals from various payers by submitting
clinical information via fax and online payer's web portals or by speaking directly to a case
management representative. We ensure end-to-end, timely, and accurate submission of prior and retro
authorization and referral requests to the payers. We pledge to make everyone aware of any changes
or implementations that may impact your financial growth.
