Pre-Authorization services in healthcare is a step in the revenue cycle management process. This comes after Insurance eligibility verification process. The output from verification process forms the base for pre-authorization process. Prior Authorization in Medical Billing helps the healthcare organization in appropriate payment collection for the services rendered, reducing denials and follow-up on the same.

What is Authorization in Medical Billing?

Authorization in medical billing refers to the process wherein the payer authorizes to cover the prescribed services before the services are rendered. This is also termed as pre-authorization or prior authorization services. As the name suggests, the approval has to be obtained from the insurance payer for the proposed treatment or services.

There are certain procedures that mandate pre-authorization from the insurance provider. During the insurance eligibility verification process, we must ensure to verify on what services require prior authorization. The approval is based on the insurance scheme of the patient. Basis the benefit terms, required medical procedures, insurance companies pre-authorize the request. A pre-authorization number is given by the insurance provider which has to be quoted in the final claim form which will be submitted post the treatment is completed.

Some of the best practices in Pre-authorization services in medical billing to ensure a smooth process are:

• Doing a thorough verification process to know the services covered to obtain pre-authorization

• Maintaining complete documentation and record of all necessary information

• Maintaining an amicable relationship with insurance providers

• Understanding the contract terms and process of various insurance providers and adhering to their guidelines to avoid delays and denials

• Having standard templates to avoid documentation and human errors

• Providing necessary training to staffs for all necessary procedures