Pre & Retro Authorization
Seamless Access to Care
Management Process
Prior authorization is a management process used by insurance companies to determine if a prescribed product or service will be covered and it’s also one of the most difficult tasks that a medical practice must take on. This process can be used for certain medications, procedures, or services before they are given to the patient. It is a challenging, and expensive process because it consumes so much of your office’s time and resources. Because of this, many healthcare systems and hospitals decide to outsource the work to an experienced medical billing company
Prior authorization services we offer:
- Prior authorization determination and requirements.
- Submission of authorization paperwork to insurance.
- Follow-up on the authorization request.
- Notification and resolution of rejection of authorization application.
How does Prior Authorization work?
Getting prior authorizations approved involves many people – primarily patients, healthcare professionals, and the patient’s health insurance companies.
Prescription Prior Authorization
When it comes to medication prior authorization, the process typically starts with a prescriber ordering medication for a patient. In many cases, providers may need to directly call the insurance companies, which often requires long periods of waiting and maybe even persistent calls for a couple of days.
Medical Prior Authorization
The prior authorization process begins when a service prescribed by a patient’s physician is not covered by their health insurance plan. Communication between the physician’s office and the insurance company is necessary to handle the prior authorization.
Provider Opinion on Prior Authorization
Many physicians are not fond of the growing number of prior authorizations needed by insurance companies in recent years. A 2019 study from the American Medical Association reported that 86% of physicians believe that prior authorizations have increased in the prior 5 years.
Why is Retro Authorization Important?
Retro Authorization holds significant importance as it ensures healthcare providers receive rightful reimbursement for their services. Without undergoing this process, providers may face non-payment for services that were not pre-authorized, placing a considerable financial strain on their ability to deliver quality care to patients.
How Does Retro Authorization Work?
Retro authorization works by allowing healthcare providers to request authorization for services that have already been provided to a patient. The provider typically submits a request to the insurance company, including all relevant information such as the patient’s medical records and a detailed explanation of why retro authorization is being requested.
This process is crucial in situations where services were not pre-authorized, providing a mechanism to retrospectively gain approval and secure reimbursement for the already-rendered medical services.
Different Types of Authorization In Medical Billing?
There are three main types of authorization in medical billing: pre-authorization, concurrent authorization, and retro authorization.
Components of a Retro Authorization Request
Patient’s Medical Records
Comprehensive documentation of the patient’s medical history and the specific services provided.
Detailed Explanation
A thorough explanation outlining the necessity for retro authorization and why the services were not pre-authorized.
Supporting Documentation
Any additional documentation supporting the retro authorization request, such as test results or physician notes.
Provider Information
Relevant details about the healthcare provider submitting the request, ensuring clarity in the authorization process.
Prior authorization services we offer:
Understanding the financial landscape of medical billing involves recognizing the profound impact that retro authorization can have on Revenue Cycle Management (RCM). Retro authorization, when mismanaged or delayed, can disrupt the smooth flow of revenue through various stages of the medical billing process.
- Delayed Revenue Recognition
- Increased Administrative Burden
- Potential Revenue Loss
- Effect on Cash Flow
Do All Insurers Allow Retro Authorization in Medical Billing?
Why Choose us
- 100% HIPAA complaint process
- 98% claims payment on first submission
- Increased efficiency owing to certified coding team
- Continuous and rigorous follow ups on denied and pending claims
- Reduced staffing issues and operating costs
- You will save almost 70% on operating costs
- No headache of staff training or update
- Quick response and answers to any billing query
- Dedicated practice manager for every practice to ensure streamlined communication
- Shortest turnaround time and faster reimbursements Cycle management by billing specialists
Year Of Experience
Medical Specialties
Happy Clients
OUR CUSTOMERS THOUGHTS
Deanna Windham
"SA Care Consultancy has been a lifesaver! They took over all our time-consuming administrative tasks, freeing us up to focus on growing our business, Their services are efficient and accurate, allowing us to trust that our daily operations are in good hands, Since partnering with SA Care Consultancy, we've seen a significant improvement in our team's productivity."
Sarah Jackson
"SA Care Consultancy is a reliable and trustworthy partner. They truly understand our business needs and deliver exceptional results
Their commitment to customer satisfaction is unmatched. They go above and beyond to ensure we're happy with their services. I highly recommended them"
Adam Smith
"SA Care Consultancy's team of medical billing experts has been a game-changer for our practice. They take care of all the complexities, ensuring accurate VOBs and timely claim submissions. It's a huge relief knowing our billing is in their capable hands, and it's allowed us to significantly reduce the stress associated with medical billing. they can be your best billing partner"
Deanna Windham
"The entire team at SA Care Consultancy are really awesome!" They are highly trained, very effective, patient with lots of questions and have helped me to improve my reimbursements significantly. I highly recommend SA Care Consultancy to any business looking to streamline operations, achieve growth, or improve their medical billing process."
Sarah Jackson
"I was initially hesitant to trust a new company, but SA Care Consultancy quickly put my worries to rest. Their team is incredibly knowledgeable and always explain everything clearly. Since partnering with them, we've seen a noticeable improvement in our revenue. Being a new company, SA Care Consultancy has provided a level of invaluable trust and reliability. I wouldn't hesitate to recommend them to anyone looking for a trustworthy and efficient medical billing solution."
Adam Smith
" They're more than just medical billing wizards they handle everything from website, marketing to customer support and even those pesky admin tasks. It's like having a whole extra dedicated team. thanks to their efforts our front desk staff can now focus on patients instead of paperwork. If you're looking to streamline operations, free up your team to focus on what matters most, SA Care Consultancy is the answer"
Reliable Convenience for all
your medical billing and RCM hassles
With SA Care Consultancy, you can conveniently stay connected from anywhere in the world and get access to all your medical related information including patient appointment scheduling, patient treatment plans and reports, scheduling updates etc. SA Care Consultancy allows you to establish a profound relationship with your patient, which is trustworthy and reliable, just as SA Care Consultancy is committed for your medical billing solutions.
Strategy and Planning
We bring the right people together to challenge established thinking and drive transform. Don't just manage billing, chart your practice's success with SA Care Consultancy. Our planning tools help you analyze data, optimize workflows, and set achievable goals.
Better Interoperability
All your medical billing workflows will synchronize easily to give you extensive information and data analytics on all your medical revenues, patient information and billing processes.
Real-time Intelligence
All your medical billing processes and workflows are automated to provide real-time information that is accurate and 100% error-free.
Frequently Asked Questions About
Prior & Retro Authorization
How long does the credentialing process take?
Turnaround time varies between insurance carriers, so there is no one answer to this question. Major carriers generally take between 90-120 days to complete the process. Smaller carriers and insurance plans may take longer.
Upon submitting a participation request to a commercial carrier, providers will need to undergo two processes. The first of these is credentialing, where the carrier verifies all provided credentials and presents them to their committee for approval. Once providers are approved by the credentialing committee, they are then directed towards the contracting process wherein their participation is approved, and they are provided their effective date.
Commercial carriers do not allow for retroactive billing, meaning providers will only be compensated for claims submitted after they are listed as an “In-Network” provider in the carrier claims system. Out of network billing will result in much larger bills for patients and patients may be responsible for the entire bill on their own.
How long does it take to enroll with Medicare?
Applications of enrollment in Medicare typically take between 60-90 days to complete, though this does vary wildly between states. The effective date for Medicare is set as the date the application was received, allowing for providers to retroactively bill for any encounters that occurred between application and approval. There is also a 30-day grace period, enabling providers to bill for service provided up to 30 days prior to their effective date.
Turnaround time is longer for DMEPOS suppliers. In addition to the close scrutiny that every application is subjected, suppliers will also be required to participate in a site visit as part of the application process. The site inspector will be responsible for ensuring the office is located at the address included on the application, as well as hours of operation, where inventory is stored, and other important elements of being a DME supplier.
Can Sa Care Consultancy make the credentialing process quicker?
Sadly, Sa Care Consultancy cannot make the process any quicker. Our contribution is efficiently and effectively managing the entire application process, beginning with initial credentialing applications and carrying through to follow-ups with carriers. Our experts are well versed in the entire process, saving time that might otherwise have been wasted by providers attempting to perform the process themselves and making mistakes along the way.
Do I need a service location to begin credentialing?
Yes, it is necessary for providers to have a place of service before they begin the medical credentialing and contracting process. A home address cannot be used as a clinic address, wither permanently or temporarily. A home address can, however, be used as an address for billing or correspondence, but only if a physical address for the practice is also provided. In the event that the office space is still under construction, the address can still be used. The application can be sent up to 30 days prior to the location actually opening up to patients, and most commercial carriers also offer the same guideline.
How do I complete Medicare Revalidation?
Revalidation of Medicare enrollment is required every 5 years but DMEPOS suppliers revalidate every 3 years. Individual providers can either complete the CMS855I paper application or use PECOS to complete the revalidation online. For groups or suppliers, the CMS855B application must be completed. If an Electronic Funds Transfer was not previously set up for the group record, one will need to be created for the revalidation process.
Providers mus