Prior Authorization Process

How To Ensure a More Efficient Prior Authorization Process

Overwhelmed physicians, primary care centers, and other providers, find completing timely prior authorizations remains a pertinent challenge that requires attention. Especially the manual process involves lots of lost time and money for a practice.

  • Tying up with phone as well as the faxes, taking days for completion, leaves your patient untreated with undue delays, accruing additional expenses for the practices.
  • The logical question that arises here is whether prior authorization and its primary goal for reducing costly medical procedure are actually achieved!
  • A centralized process, using relevant technology to track prior authorization, a compilation of lists of the alternative medications and required documentation to speed up the process is an indispensable component of modern practice management.
  • There are constantly changing forms or payer web portals and a static approach with EMR or practice management systems is a huge mistake.
  • Taking into account the lack of training of medical staff involved, the time consumed with physicians involved in tedious paperwork, it kills a practice of valuable time and productivity.
  • Each region also has its unique provider-payer mix as well as plans and it is almost impossible to have standardized workflows.
  • Each payer for instance also has its own web portal and even fax forms that map with its internal workflows.
  • A combination of processes, practices of electronic and manual prior authorization that is flexible is going to be the need of the hour!
Prior Authorization Process

It is estimated that on an average nearly 869 million hours are spent in obtaining prior authorizations. With an annual cost worth $31 billion being spent on prior authorizations, it is necessary for providers to implement a sound methodology that reduces pain in general practice management priorities!

Automation in the process of prior authorization, eligibility, and referrals is going to be a critical job on hand to ensure. The Medicare and Medicaid cuts as expected will require providers to take active steps and implement processes, resources that can better their overall prior authorization process.

"Prior Auth Online" could just be the solution!

Sun Knowledge has developed our own proprietary platform "prior auth online" incorporating the best practices of leading practice management systems. We are flexible to work with any billing software and platforms helping you with tailored prior authorization services. Our simple, reliable and linear process with an expert prior auth team will eliminate pain points in your general practice management efforts.

Our 360-degree prior authorization approach

As a 100% HIPAA compliant revenue cycle management company, Sun Knowledge is currently working with leading payers and providers. We have tons of references from over 100 clients that speaks volumes about our credibility and best practices. As a stand-alone service, we are currently providing our prior authorization services for just $7 per hour! We will function as your reliable operational extension, help you focus better on your patients with a complete action plan in the prior authorization. We will:

  • Gather important procedural information from patient as well as provider
  • Determine the eligibility coverage
  • Validate prior auth request with effective payer communication
  • Initiate PA request as per payer requirements
  • Checking for authorization status
  • Follow up with ordering physicians with documents of relevance
  • Provide additional information as per payer requests
  • Update the authorization outcome in the PM/ billing system

Sun Knowledge processes almost 50,000 prior authorizations on a daily basis making us your desired partner for handling any amount of volume!

One of our success stories

One of our clients, a health plan associated with both Medicare and commercial business and CMS regulatory requirement was using a semi-automated process for prior authorization address. They had to access multiple systems to gather information on the decision that had to be communicated as results across the organization.

The business challenges

The client needed complete documentation and maintaining CMS compliance on a 24/72 turn around basis. They required a partner who had the ability to handle new business requirements without adding extra staff. Also, they had their complex operational reporting and dissemination of the PA data to the enterprise systems.

Our solution!

We provided the client complete support and handled annual peak volume with 70% of the previous staffing levels. Effective customer service was provided with integrated PA data and a one-stop point for answering all queries. We managed easier compliance with CMS processing needs using customized queues and alerts. The time reduction in phone calls, inbound fax handling, sorting and letter generation was reduced with our pre-notification, peer to peer notification capabilities.

Our experts are just a call away! Let us explain our value proposition, share our references with you. We guarantee you seamless communication standards, customized reporting of the highest order and dedicated account management support.