A pre-service authorization and medical necessity solution for healthcare providers that want to automate authorization workflows, reduce denials and bad debt risk, and increase efficiency.Contact Us
Help Accelerate Prior Authorization
Automate manual processes by determining if a pre-authorization is required and on file with the payer.
Monitor payers electronically for pending pre-authorization decisions with results automatically posted to your health information system.
Create a consistent workflow for manual intervention of pre-authorization follow-up to ensure mission-critical steps are not overlooked.
Help reduce authorization-related claim denials by accessing an audit trail where the authorization verification was obtained and results were stored.
Help reduce losses due to write-offs by automating Medical Necessity checking as part of registration, and perform clinical code auditing for Medicare outpatient services.
Create Advanced Beneficiary Notices with expected charges for the patient which allows them to accept liability prior to care delivery.
Automated Payer Screening and Verification
Streamline prior authorization workflow
- Initiate the authorization process by receiving electronic messages from the scheduling platform to alert your team if work is required before the account reaches pre-registration.
- Utilize multiple payer access strategies to make sure all services are reliably screened and verified against each payer’s pre-authorization requirements.
- Submit Notices of Admission electronically to 278 and portal payers in real time.
Verify medical necessity and clinical codes
- Confirm within the financial clearance workflow if an Advance Beneficiary Notice is required.
- Check clinical codes in real time against Medicare rules, and trigger medical necessity checks for Medicare Advantage plans using plan code-based rules.
- Confirm ongoing compliance with the latest audit rules by leveraging regularly updated Local and National Coverage Determination content services to support comprehensive Medicare compliance.