Prior Auths

When you don’t get the necessary preauthorization who gets stuck with the bill: You.

Why Prior Authorizations Matter

Few words arouse more frustration among physicians than “prior authorization”.

It’s easy to understand why.

The time you and your staff spend persuading an insurance company to cover a medication, imaging or procedure is an expensive, annoying and a distraction from patient care.

Now the good news: PASSlink prior authorizations are without the hassle or the expense.

PASSLink eases the prior authorization burden

You can use PASSlink services to effortlessly request, receive and track service authorizations when needed.

PASSLink Prior authorizations

  • Are easy, automatic and web based
  • Include medications, imaging, procedures and referrals
  • Cross all payers that offer them
  • Are based on CPTs
  • Affordable
  • Use a combination of necessity, appropriateness and patients benefit limits .. that’s smart!

Prior Authorizations challenges and PASSLink Solution

The burden of obtaining necessary authorizations is largely on the provider, because it’s the provider who’ll be denied payment as expected.

Getting authorizations saves countless hours on the back end trying to chase payments.

Most payers don’t issue retro authorizations, even when the failure to get preauthorization was just a mistake.

Some may overturn a denial on appeal, but they’re under no obligation to make payment if the proper process was not followed.

Occasionally you run into a situation where the authorization was obtained prior to services, and the patient’s employer terminates benefits retroactively for whatever reason. In these very unfortunate situations, the patient is responsible for the medical fees, but the practice is duly paid for services it rendered because the service was pre approved.

Tip: The key to a solid prior authorization is to provide the correct CPT code with the correct ICD10 code.

The challenge is that you have to determine the correct procedural code before the service has been provided – an often difficult task but not with PASSLink.