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💼How to Efficiently Submit Prior Authorization for Pediatric Diabetic Supplies? | A Case Study |

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Read the Article at https://hie.li/O8l1

𝗜𝗻 𝗽𝗲𝗱𝗶𝗮𝘁𝗿𝗶𝗰 𝗲𝗻𝗱𝗼𝗰𝗿𝗶𝗻𝗼𝗹𝗼𝗴𝘆, 𝘀𝗲𝗰𝘂𝗿𝗶𝗻𝗴 𝗽𝗿𝗶𝗼𝗿 𝗮𝘂𝘁𝗵𝗼𝗿𝗶𝘇𝗮𝘁𝗶𝗼𝗻 𝗳𝗼𝗿 𝗱𝗶𝗮𝗯𝗲𝘁𝗶𝗰 𝘀𝘂𝗽𝗽𝗹𝗶𝗲𝘀 𝗹𝗶𝗸𝗲 𝗴𝗹𝘂𝗰𝗼𝘀𝗲 𝘀𝗲𝗻𝘀𝗼𝗿𝘀 𝗶𝘀 𝗲𝘀𝘀𝗲𝗻𝘁𝗶𝗮𝗹 𝘁𝗼 𝗺𝗮𝗶𝗻𝘁𝗮𝗶𝗻𝗶𝗻𝗴 𝗰𝗼𝗻𝘁𝗶𝗻𝘂𝗼𝘂𝘀 𝗰𝗮𝗿𝗲 𝗳𝗼𝗿 𝘆𝗼𝘂𝗻𝗴 𝗽𝗮𝘁𝗶𝗲𝗻𝘁𝘀. These tasks can be time-consuming and prone to errors if not handled properly. This case study shows how Staffingly, Inc., through their expert prior authorization specialists and virtual medical assistant services, streamlined the process to ensure timely approvals and uninterrupted patient care.

🚩 𝗖𝗵𝗮𝗹𝗹𝗲𝗻𝗴𝗲𝘀 𝗶𝗻 𝗦𝘂𝗯𝗺𝗶𝘁𝘁𝗶𝗻𝗴 𝗣𝗿𝗶𝗼𝗿 𝗔𝘂𝘁𝗵𝗼𝗿𝗶𝘇𝗮𝘁𝗶𝗼𝗻𝘀 Handling prior authorizations for diabetic supplies requires precision and close attention to detail. Common challenges include:

• Ensuring complete and accurate documentation.
• Re-submitting expired or delayed authorizations.
• Attaching necessary documents, such as clinical and diagnostic reports.
• Completing Continuity of Care (COC) forms for ongoing care.
• Faxing COC documents to insurers like Sunshine Medicaid.

These complex steps can slow down the process and delay treatment. Staffingly, Inc. uses virtual medical assistants who specialize in efficiently managing these tasks.

💡 𝗧𝗵𝗲 𝗦𝗼𝗹𝘂𝘁𝗶𝗼𝗻: 𝗘𝗳𝗳𝗶𝗰𝗶𝗲𝗻𝘁 𝗣𝗿𝗶𝗼𝗿 𝗔𝘂𝘁𝗵𝗼𝗿𝗶𝘇𝗮𝘁𝗶𝗼𝗻 𝗯𝘆 𝗩𝗶𝗿𝘁𝘂𝗮𝗹 𝗠𝗲𝗱𝗶𝗰𝗮𝗹 𝗔𝘀𝘀𝗶𝘀𝘁𝗮𝗻𝘁𝘀

Staffingly, Inc. assigned a prior authorization specialist to handle a request for pediatric patient John Doe, who needed diabetic sensor supplies. This involved re-submitting expired authorizations and completing necessary documentation to meet insurer requirements.

𝗦𝘁𝗲𝗽-𝗯𝘆-𝗦𝘁𝗲𝗽 𝗪𝗼𝗿𝗸𝗳𝗹𝗼𝘄: 𝗦𝘁𝗮𝗿𝘁𝗶𝗻𝗴 𝗮 𝗡𝗲𝘄 𝗣𝗿𝗶𝗼𝗿 𝗔𝘂𝘁𝗵𝗼𝗿𝗶𝘇𝗮𝘁𝗶𝗼𝗻 𝗥𝗲𝗾𝘂𝗲𝘀𝘁

The specialist accessed patient information, verified the expired prior authorization, and initiated a new request in the CoverMyMeds (CMM) portal using a pharmacy-generated key.

𝗥𝗲-𝗦𝘂𝗯𝗺𝗶𝘁𝘁𝗶𝗻𝗴 𝗘𝘅𝗽𝗶𝗿𝗲𝗱 𝗔𝘂𝘁𝗵𝗼𝗿𝗶𝘇𝗮𝘁𝗶𝗼𝗻𝘀: The previous request expired in October, and the patient’s appointment was in December. The specialist confirmed Medicaid coverage and resubmitted the prior authorization.

𝗖𝗼𝗺𝗽𝗹𝗲𝘁𝗶𝗻𝗴 𝘁𝗵𝗲 𝗖𝗢𝗖 𝗙𝗼𝗿𝗺: Since it was a Medicaid plan, the specialist collected the patient’s Member ID, diagnosis code, and other details, completing and submitting the COC form.

𝗠𝗲𝗿𝗴𝗶𝗻𝗴 𝗮𝗻𝗱 𝗔𝘁𝘁𝗮𝗰𝗵𝗶𝗻𝗴 𝗗𝗼𝗰𝘂𝗺𝗲𝗻𝘁𝘀: The specialist attached two recent office visit notes (September and October) along with the COC form, merging them into a single PDF per Sunshine Medicaid guidelines.

𝗙𝗮𝘅𝗶𝗻𝗴 𝘁𝗵𝗲 𝗖𝗢𝗖 𝗘𝘅𝘁𝗲𝗻𝘀𝗶𝗼𝗻: The COC extension was faxed to Sunshine Medicaid, and the specialist confirmed the successful submission and documentation.

𝗗𝗼𝗰𝘂𝗺𝗲𝗻𝘁𝗶𝗻𝗴 𝗮𝗻𝗱 𝗧𝗿𝗮𝗰𝗸𝗶𝗻𝗴: The specialist logged the task in a shared Google sheet, ensuring all steps were recorded for easy follow-up.

🎯 𝗥𝗲𝘀𝘂𝗹𝘁𝘀: Timely Approval and Streamlined Workflow

By using Staffingly, Inc.’s virtual medical assistants, the clinic was able to:

✅ Quickly re-submit the prior authorization, avoiding delays.
✅ Complete the COC form and submit it with all required documentation.
✅ Ensure faster approval of diabetic sensor supplies, maintaining patient care.
✅ Reduce the administrative burden on healthcare providers, allowing them to focus on patients.

📌 𝗞𝗲𝘆 𝗧𝗮𝗸𝗲𝗮𝘄𝗮𝘆𝘀 𝗳𝗼𝗿 𝗘𝗳𝗳𝗶𝗰𝗶𝗲𝗻𝘁 𝗣𝗿𝗶𝗼𝗿 𝗔𝘂𝘁𝗵𝗼𝗿𝗶𝘇𝗮𝘁𝗶𝗼𝗻 𝗦𝘂𝗯𝗺𝗶𝘀𝘀𝗶𝗼𝗻

• Timely Re-Submission: Tracking deadlines, like using a Google sheet, helps avoid delays in prior authorizations.
• Accurate Documentation: Completing COC forms and attaching all required documents in one PDF ensures quick approvals.
• Utilizing Fax for COC Extensions: Certain insurers require faxed documents, which virtual medical assistants handle efficiently.
• Tracking and Follow-Up: Recording all steps in the authorization process ensures nothing is missed and makes follow-up easier.

⭐ 𝗪𝗵𝘆 𝗖𝗵𝗼𝗼𝘀𝗲 𝗦𝘁𝗮𝗳𝗳𝗶𝗻𝗴𝗹𝘆, 𝗜𝗻𝗰. 𝗳𝗼𝗿 𝗣𝗿𝗶𝗼𝗿 𝗔𝘂𝘁𝗵𝗼𝗿𝗶𝘇𝗮𝘁𝗶𝗼𝗻?

🏆 𝗘𝘅𝗽𝗲𝗿𝗶𝗲𝗻𝗰𝗲𝗱 𝗦𝗽𝗲𝗰𝗶𝗮𝗹𝗶𝘀𝘁𝘀: Our experts handle complex submissions, re-submissions, and form completions.
🗂️ 𝗘𝗳𝗳𝗶𝗰𝗶𝗲𝗻𝘁 𝗗𝗼𝗰𝘂𝗺𝗲𝗻𝘁 𝗠𝗮𝗻𝗮𝗴𝗲𝗺𝗲𝗻𝘁: We ensure deadlines are met with real-time tracking.
📠 𝗦𝗲𝗮𝗺𝗹𝗲𝘀𝘀 𝗦𝘂𝗯𝗺𝗶𝘀𝘀𝗶𝗼𝗻𝘀: Faxing and electronic submissions reduce errors and improve approval times.
🌍 𝗚𝗹𝗼𝗯𝗮𝗹 𝗡𝗲𝘁𝘄𝗼𝗿𝗸: Our virtual assistants manage insurance verification, prior authorizations, and medical billing.

❓ 𝗙𝗔𝗤𝘀

𝗤: 𝗪𝗵𝗮𝘁 𝗿𝗼𝗹𝗲 𝗱𝗼 𝘃𝗶𝗿𝘁𝘂𝗮𝗹 𝗺𝗲𝗱𝗶𝗰𝗮𝗹 𝗮𝘀𝘀𝗶𝘀𝘁𝗮𝗻𝘁𝘀 𝗽𝗹𝗮𝘆 𝗶𝗻 𝗽𝗿𝗶𝗼𝗿 𝗮𝘂𝘁𝗵𝗼𝗿𝗶𝘇𝗮𝘁𝗶𝗼𝗻?

A: They handle administrative tasks, including initiating and tracking authorizations, ensuring accurate document submissions, and managing insurance communications.

𝗤: 𝗪𝗵𝘆 𝗶𝘀 𝗳𝗮𝘅𝗶𝗻𝗴 𝘀𝘁𝗶𝗹𝗹 𝘂𝘀𝗲𝗱 𝗳𝗼𝗿 𝘀𝗼𝗺𝗲 𝗽𝗿𝗶𝗼𝗿 𝗮𝘂𝘁𝗵𝗼𝗿𝗶𝘇𝗮𝘁𝗶𝗼𝗻𝘀?

A: Some insurers, like Sunshine Medicaid, require faxed COC forms. Virtual assistants manage this process efficiently.

𝗤: 𝗛𝗼𝘄 𝗱𝗼𝗲𝘀 𝗦𝘁𝗮𝗳𝗳𝗶𝗻𝗴𝗹𝘆, 𝗜𝗻𝗰. 𝗲𝗻𝘀𝘂𝗿𝗲 𝗳𝗮𝘀𝘁𝗲𝗿 𝗮𝗽𝗽𝗿𝗼𝘃𝗮𝗹𝘀?

A: With specialized prior authorization experts, we ensure documentation accuracy and timely follow-ups, leading to faster approvals.

For more information on how Staffingly, Inc. can streamline your clinic’s prior authorization process, contact us at:

🌐 www.staffingly.com
📧 support@staffingly.com
📞 Call Toll-Free: (800) 489-5877