In our experience working with medical practices, we have observed that a large number of denials happen because a patient is not eligible or authorized for services billed to the payer. We help you to dramatically reduce the prior-authorization denials, by obtaining prior-authorization well before the patient’s scheduled appointment. Therefore, the patient’s obligation is clear and available at the point of service, thus accelerating the payment before the visit even begins. In addition, it helps in filing clean claims, resulting in reduced accounts receivable days and increased collections.
TriumpHealth prior-authorization services include:
- Submitting prior-authorizations to payers proactively
- Timely follow-up on prior-authorizations not received or denied
- Medical records submission as needed for prior-authorization processing
- Working with the practice to gather letters and templates such as:
- Description of procedure letters
- Medical necessity letters
- Description of unlisted drugs or procedures
- Appeals templates
- Field phone calls from payer clinical staff
- Provide clinic feedback to the practice on payer guidelines and requirements