Pre-authorization, prior approval, or pre-certification—all refer to gaining approval from an insurance provider before a doctor administers services to a patient. This confirmation from the payer regarding the medical necessity of a procedure, treatment plan, medical equipment, or prescription results in an authorization number necessary for claim submission.

These steps within revenue cycle management hold critical importance. Obtaining pre-authorizations delivers several advantages, including:

• Accountability and cost containment
• Decreased denials and improved collections
• Lessened write-offs
• Increased revenue

The process of obtaining prior authorizations and referrals involves various methods such as:

• Phone calls
• Online forms
• Sending faxes through EMR

Each method demands time and adds administrative burdens to your staff. These tasks consume valuable time that could be dedicated to enhancing and ensuring the quality of patient care. Moreover, staying updated on the diverse guidelines of different payers, which frequently evolve, requires substantial effort, further contributing to the administrative workload.