Prescription Prior Authorization
Prescription Prior Authorization is used by insurance companies to determine if they will cover a medication prescribed by a healthcare provider. The provider has to obtain approval from the insurance company before medication can be dispensed to the patient.
Instapay Healthcare Services’ covers prescription prior authorization under its expert-crafted medical billing services. Our solutions ensure that the patient’s prescribed treatment is medically necessary, cost-effective to both the provider as well as patient, and appropriate according to the insurer’s guidelines.
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The Process of Prescription Prior Authorization
- Medication that requires prior authorization is prescribed by the healthcare provider. Prescription is needed for a brand-name drug, a specialty medication, or a treatment that is not covered under the insurance plan.
- Submission of request by healthcare provider to the insurance company. This request includes details about the patient's medical history, prescribed medication, diagnosis and why a particular drug is recommended.
- Insurance company undertakes review of information given by the healthcare provider. By assessing whether the medication is medically necessary, searching if any possible alternative treatments that are more cost-effective, and if the drug is included in the insurance formulary.
- After the review, the insurance company either approves, denies, or requests more information.
- If the prescription prior authorization is denied, the healthcare provider or patient can appeal the decision, by submitting additional medical documentation or finding alternative solutions.
Reasons to Carry Out Prescription Prior Authorization
Cost management for healthcare providers and patients as patients will only receive medications that are covered under a patient’s insurance plan.
To prevent overuse, misuse, or drug interactions, so that the prescribed medication is the most suitable option.
Insuring companies usually prefer certain generic medications or formulary options over brand-name drugs.
Benefits of Partnering with Instapay Healthcare Services for Prescription Prior Authorization
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Faster processing times as processes at Instapay Healthcare Services are taken care of by industry experts.
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Outsourcing prescription prior authorization helps healthcare organizations reduce costs by allowing you to access Instapay Healthcare Services’ expertise without the need to hire and maintain an in-house team.
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Improved accuracy as each prescription and patient case is reviewed by our team of professionals who know ins and outs of medical billing and coding.
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We understand it very well that your healthcare practice grows and changes with time. Keeping this in mind, all our solutions are flexible and scalable as per your needs.
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Regulatory compliance with HIPAA and state and federal regulations is at the center of all our solutions. With such a work approach, we help healthcare providers reduce risk of denials due to procedural mistakes.
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From intensive paperwork, follow-ups, and communication between healthcare providers, insurance companies and patients, Instapay Healthcare Services handles all administrative tasks. As your staff is freed up, they can focus better on patient care.
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Our deep understanding of prescription prior authorization processes and specific requirements of different insurance companies help ensure compliance and reduce errors risk.