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Benefit
verification and precertification of services has increased the
administrative
burden on your customers often to the point that it can impede a sale.
As
a new line of business Reimbursement Revenue Solutions will begin
offering these
services as of March 1st.
The
objective of this service is to
determine if the procedure, drug, biological or supply is a covered
benefit and
if prior authorization or predetermination is required. How the service
works is
like this:
- The procedure
consist of obtaining information from the provider
- The office completes the patient information worksheet
(we
provide) and
the patient also signs a consent (also provided) form along with a
copy
of the patient's insurance card (front and back)
- This information is sent via email or fax (HIPAA fax
line)
- Once the entire information is obtained from the
provider,
the provider is
contacted letting them know that the request is received and complete
- Payer Medical Policy is accessed to confirm coverage
and the
precertification process begins
- If no prior authorization or predetermination is
required a
completed
response is signed and dated and returned to the provider
- If a prior authorization of predetermination is
required the
provider is
contacted if additional information is required to complete the
process
- At this point, the payer is contacted every two days to
check
the status
of the authorization
In the event there is a
denial,
a request from the plan is performed to determine what is needed for an
appeal,
which we handle.
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