Prior Authorization & Eligibility

Ease your medical billing process by outsourcing to us for accurate insurance claims filing. We not only manage claims and denials but also ensure the verification of benefits and eligibility before submission. Our services include verifying patient coverage and benefits, initiating prior authorization requests, checking patient schedules, and entering patient demographic information to ensure an efficient claims process.


Checking patient schedules

Entering patient demographic information

Verifying patient coverage

Verifying patient benefits

Initiating prior authorization requests

Services for Prior Authorization in San Diego

Our Services for Prior Authorization, Eligibility, and Benefits Verification

Having a claim denied and needing to refile can waste valuable time and resources. To prevent this, we offer services to verify that a patient has the necessary insurance coverage for a specific claim before filing, reducing the risk of denial.

  • Prior authorization: Prior authorization refers to the process of obtaining approval from an insurance company before a patient receives a treatment or medication. This step can help minimize the risk of claim denial, as the insurance provider has already approved the specific treatment.
  • Coverage Verification: Coverage verification and benefits verification are two distinct processes in medical billing. While benefits verification confirms what medical services a patient’s insurance plan will cover, coverage verification confirms whether the patient had valid insurance at the time of treatment. The timing of insurance coverage is crucial in determining the viability of a claim, just as much as the services covered by the patient’s insurance plan.
  • Benefits Verification: We conduct a thorough verification of a patient’s insurance benefits to ensure that the proposed medication or treatment is covered before proceeding with the treatment. This proactive approach helps minimize the chances of claim rejection and denials.
  • Data Entry Prior to Patient Visits: Ideally, most of the verification process should be completed before the patient’s visit. This involves coordinating with the patient to schedule the appointment and collecting their insurance information for verification. While prior authorization may not be feasible until the treatment is determined, completing as much verification as possible before the patient’s visit can help expedite the collections process.

A More Profitable Practice – Increase
collections by 15%

INHOUSE MEDICAL BILLING

$1,200,000 revenue

  • $45,000 biller salary
  • $40,000 secondary biller salary
  • $23,750 Benefits and Overhead @ 25% of salary
  • $3,000 Cost of software and hardware for billers
  • $1,200 Cost of Postage

$1,087,000 in net collections

Average billing expense of 10.25% of collected revenue

OUTSOURCED MEDICAL BILLING

$1,400,000 17% increase in top line collected revenue

  • $77,000 5.5% of collected revenue

$1,323,000 in net collections

Average billing expense of 5.5% of collected revenue plus the added collective revenue from outsourcing

Benefits of Prior Authorization in San Diego

Benefits of Prior Authorization, Eligibility, and Benefits Verification Services

Verifying patient eligibility and benefits, as well as obtaining prior authorization, can significantly expedite the claims process. By ensuring that patients have the necessary coverage for their treatment and receiving prior approval from the insurance company, medical billing professionals can speed up collections and minimize the likelihood of claim denials by payers.

  • Reduced Risk of Claim Denials: By obtaining prior authorization for treatment and verifying patient coverage, the risk of the payer denying the claim is significantly reduced. This not only ensures that you receive the collections you’re owed in a timely manner, but it also saves you the hassle of having to refile the claim or appeal a denial.
  • Faster Collections: By verifying patient insurance coverage and benefits before their visit to your practice, we can significantly reduce the time it takes to code and file a claim. This process, combined with outsourcing, can decrease the time spent in Accounts Receivable by up to 19 days and ultimately lead to faster collections for your practice.
  • Flexibility to Meet Insurance Company Requirements: Our extensive experience in working with various insurance companies has allowed us to customize our claims filing process according to their specific requirements. This ensures that we optimize collections while reducing the time it takes to receive them.
Testimonials

What our clients are saying

Branden R.
Branden R.
22:38 03 Aug 23
I spoke with Brian today from Sharp Management Solutions. He was a pleasure to chat with and he seems very knowledgeable. Having your medical billing handled by specialists seems like a great way for medical offices to spend less effort and collect more money from their patients at the same time.
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If you're tired of the stress and hassle of managing your medical billing in-house, contact us today to learn more about our reliable and cost-effective medical billing services and start streamlining your operations for increased efficiency and profitability.