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.