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Insurance Verification & Pre-Authorization

The need to verify a patient’s insurance coverage and obtain pre-authorization for certain procedures has grown steadily. Unfortunately, staffing levels at most healthcare providers has not kept pace with the burden of this time-consuming process. Not obtaining insurance verification or adequately documenting pre-authorization can mean delayed claim processing or denial of payment.

More and more healthcare providers are turning to KeyMed Partners to handle insurance verification and pre-authorization. Having an experienced team of experts to manage the process provides a more reliable reimbursement rate, speeds up payment processing and reduces errors. More importantly, it eliminates this headache for your staff, allowing them to focus on patients, not paperwork.

Insurance Verification

  • Verify valid appointments
  • Confirm insurance coverage or Medicare eligibility
  • Update patient with active insurance information
  • Note if pre-certification or pre-authorization is required
  • Contact patient to update demographics, if no appointment in past 6 months
  • Provide insurance verification performance standards and measurements
  • Report weekly and monthly activity

Pre-authorization

  • Identify procedure and diagnosis codes
  • Verify procedure codes requiring pre-authorization
  • Contact patient’s insurance to confirm necessity of pre-authorization
  • If pre-authorization is required – determine if authorization is already on file; contact patient’s insurance with CPT and diagnosis codes and DOS; document authorization number or the status of a pending authorization
  • If pre-authorization is not required – document file with appropriate information and name of insurance representative
  • If procedure is not covered or won’t be authorized – contact healthcare provider to notify them that procedure is not covered

Our insurance verification and pre-authorization specialists have experience dealing with all major insurers across the country such as Blue Cross Blue Shield, United Healthcare, AETNA, etc.

  • 3607 Rosemont Avenue, Suite 401
  • Camp Hill, PA 17011
  • Toll Free: 855-453-9633
  • Direct: 717-214-3003
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  • All Rights Reserved.