Authorization and Referral Management

Authorization and Referral Management

Another greatest contributor to lost revenue is the failure to obtain a referral or authorization before performing a procedure as the most common denial in medical billing reimbursement rates as Pre-Authorization, Prior Authorization, Pre-Certification, and Notification. Not all services and procedures require a referral or pre-authorization, but if a referral or pre-authorization is required and is not obtained, reimbursement for the procedure is put at risk.

Authorization is the process of getting a medical service(s) authorized from the insurance carrier. Providers or Medical billing companies have to contact insurers in advance and obtain a certification number in order to be reimbursed properly. These processes result in an authorization and referral number and provider’s/billing companies must use on claims submitted for payment.

Advantage Medical Billing’s referral and pre-authorization services ensure that the patient is approved for the planned service or procedure before arrival, ensuring that the first stage of the revenue cycle is completed accurately. This sets the rest of the claims process up for success.

Our authorization and referral management solutions provide access to the functionality your staff needs to verify insurance eligibility and make sure the proper patient authorizations and referrals are in place to ensure reimbursement.