Prior-Authorization Archives

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PRIOR AUTHORITAIZATION PROCESS, REQUIREMENTS, RULES, DIFFERENCE, SUMMARY

Author: Mythili Suresh PRIOR AUTHORIZATION PROCESS OBJECTIVE – In-some cases under the medical and prescription drug plans, some of the major treatments, procedure and medications may need approval from your health insurance carrier before you receive care from the provider of health insurer. INTRODUCTION – Prior authorization is usually claims to require if you need a complex treatment, mitigation, Prevention or prescription. Since the maximum Coverage will not happen without the prior authorization process. And hence that was the major

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Prior-Authorization

Prior Authorization

Author: Zaibunnisa Begum Prior Authorization is a process of cost control in a health plan, where the physicians or any other health care providers are required to obtain approval in advance from the registered insurance company before delivering any specific service to the patient for medical payment coverage. Prior Authorization is also sometimes called as Pre-Certification and Pre- Approval. The main concept of the prior authorization process is to make sure that an individual receives access to all medical

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Effective Methods for Managing Compliance in Electronic Health Records

Prior-Authorization

Outsourcing Prior Authorization Process: An Approach to Optimizing Your Revenue Cycle and Improving Patient Care

Author: Dr. Aamer Nawaz Syed, Pharm. D Prior Authorization Specialist at Staffingly, Inc. What is Prior Authorization? It is a health insurance company utilization management approach that requires certain operations, tests, and drugs ordered by healthcare practitioners to be assessed for medical necessity and cost-of-care implications before they are permitted. A health insurance payer’s choice to approve or reject a prescribed course of treatment based on the results of a prior authorization review will influence whether a provider or pharmacy

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