Authorizations and Referral Services
Back Office Support
Authorizations and Referrals
Pre-authorization, prior approval, or pre-certification—all these terms refer to obtaining prior approval from an insurance payer before a doctor provides services to a patient. This confirmation by the payer that a procedure, treatment plan, medical equipment, or prescription drug is medically necessary results in an authorization number that must be included on the claim when submitted.
A referral, on the other hand, is when a primary care physician (PCP) recommends a patient to a specialist for consultation or healthcare services they are unable to provide. Many insurance companies require this step before agreeing to pay for a visit to a specialist. To file a successful claim, you must have this referral on file for your patients.
These steps in the revenue cycle management process are critical. Obtaining pre-authorizations or ensuring you have a referral can provide several advantages:
The process for obtaining prior authorizations and referrals can be done in various ways, such as:
All these methods take time and add an administrative burden on your staff—time that could be better spent ensuring the quality of patient care is delivered and maximized. Additionally, your staff needs to stay updated on various payer guidelines, which continually change. Keeping up with these changes is time-consuming.
Billed Right helps save you time and reduce your denials!
Understanding all the intricacies of obtaining pre-authorizations and referrals is crucial to avoiding lost revenue and preventing a negative financial impact on your practice. Billed Right has the expertise to help you manage what can sometimes be a very complex process. To learn more about how Billed Right can help you with authorizations and referrals, contact us today!
Our Expertise
Outsourcing Prior-Authorization and Referrals is the Best Option
At Billed Right, our Authorizations and Referral Services provide doctors with the additional resources needed to obtain necessary pre-authorizations and referrals, ensuring claims are submitted with the required information for each payer. This offers a more optimized workflow, saving you time and money.
With our authorization and referral service, you can expect:
