Clearance Authorization

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.

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Help Accelerate Pre-Authorization

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Automate manual processes by determining if a pre-authorization is required and on file with the payer.

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Monitor payers electronically for pending pre-authorization decisions with results automatically posted to your health information system.

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Create a consistent workflow for manual intervention of pre-authorization follow-up to ensure mission-critical steps are not overlooked.

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Help reduce authorization-related claim denials by accessing an audit trail where the authorization verification was obtained and results were stored.

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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.

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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

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Streamline pre-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.
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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.

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