The time consuming nature of manual prior authorization services, with data entry and the challenging nature of tracking can deviate you from focusing on your patients. Traditional processes with lack of transparency, long waiting periods can lead to lack luster patient engagement efforts even leading to drastic consequences.
Exploring options and choosing the ideal among prior authorization companies can be a confusing job. That’s why; we can be your potential guide to deliver tailored prior authorization solutions!
Our exceptional prior authorization services simplify the pre certification process needed for hospital admissions, surgeries, outpatient procedures, and more. Ensuring that all the payer’s requirements have been fulfilled before submitting a pre-authorization request, to form-completion and document submission, to following up on the submitted request, we provide end-to-end solutions for the smoothest experience through every step of the Pre Authorization requesting process.
We reduce reimbursement turnaround time by minimizing lengthy paperwork, and our streamlined processes allow us to complete more prior authorization requests with a better success rate.
An effective prior authorization solution
We have ideal understanding of the latest guidelines in pre authorization in medical billing and can actually help you in resolving your practice management blunders. Our team of prior authorization management knows how to:
- Initiate prior authorization request
- Ensuring that documents/ details are collected from the physician office
- Working with both payer and provider office
- Following up on the authorization outcome/ status
- Knowing whether there is any need of additional documents
- Updating the authorization outcome in the client PM/ billing system
If you are finding it tough to manage your prior authorization for medical services in house, our team of insurance authorization specialists can actually help in eliminating proven pain points in your revenue cycle with our specialized intervention. Moreover, we are a powerhouse when it comes to handling outsource prior authorization company across multiple specialties.
Our action plan in prior authorization services
One of the major challenges is with prior authorization. Every provider loses dollars in millions due to lack luster prior authorization process.
- Verification of Patient Data
- Inability to prove medical necessity
- Insufficient Documentation
In these times of rising operational expenses and scarcity of finding specialized team of insurance verification/authorization specialists, we are your best bet when it comes to managing everything from start to finish as a dedicated prior authorization company. Our team of prior authorization experts will automate the process of submission and make tracking and management prior authorization requests simpler!
Our Other Comprehensive Services:
As a leading prior authorization company, we offer an extensive range of services to support healthcare providers in simplifying their revenue cycle management.
Our pre-authorization solutions comprise:
1. Verification Services
We meticulously verify each patient’s insurance to confirm that the prescribed treatment or medical procedure is covered under their plan, thereby reducing errors and denials.
2. Documentation Services
We use a cutting-edge documentation approach to ensure a smooth and trouble-free prior authorization process in medical billing, including doctor’s office follow-ups. Our standard approach significantly speeds up the overall pre-authorization process.
3. Hassle-free Claim Settlements
We have experts with a complete understanding of the present industry mandates and authorization guidelines, possessing extensive knowledge of insurance eligibility processes, ensuring hassle-free claim settlements on the first attempt of up to 97%.
4. Managing Complex Coding
With a comprehensive understanding of the coding environment, our trained coders help utilize the correct ICD-10 diagnosis codes for prior authorization documentation to prevent delays and eliminate denials.
5. Follow-Up Services
Our authorization specialists monitor all pre authorization requests to eradicate communication gaps between the parties. We guarantee swift authorization services approvals and seamless claim settlements. We also follow up consistently with Medicare teams to prevent delays.
6,128,000+
Transcription lines
432,000+
Charge entries
6,571,000+
Payment postings
5320+
Demo entries
TESTIMONIALS
You and your team are doing a wonderful job! We are very fortunate to have Sunknowledge and your expertise in the authorization process. Thanks again for all you do.
Client Success Story
Case Study in Prior Authorization
Today Prior authorization is one of the complex domains where most providers complain of losing out money and end up with frequent denial. This case study will help you understand how partnering with SunKnowledge helped. Read the Case Study >>
Why Choose Us for Prior Authorization Services?
We are among the top prior-authorization service providers with 18+ years of extensive experience. The advantages of partnering with us for your pre authorization needs include:
- Affordable Pricing: We provide our services at incredibly competitive rates, with prices starting at $7/per hour and no hidden fees.
- Data Security: We are an ISO 27001:2022 certified company, ensuring complete safety and security of the data you share with us.
- HIPAA Compliant Services: We guarantee full HIPAA compliance while maintaining the highest standards and productivity levels.
- Maximized Reimbursements: Our end-to-end process guarantees seamless and efficient handling of pre authorization, reducing write-offs and the denial rate.
- Fast Turnaround Time: Our systematic approach ensures rapid documentation and swift approval rate.
- Reduced Operational Costs: Our pre authorization services help you save up to 80% on operational cost, thereby boosting your profits.
Other Services You Can Benefit From
Medical Billing Services
Physician Billing Services
Full Revenue Cycle Management
Outsource Prior Authorization Services to SunKnowledge
We as a leading prior authorization company offering a variety of services dealing with all your billing needs to clients worldwide. Our team of experienced professionals is dedicated to help healthcare providers simplify the complex pre authorization process, allowing them to focus on delivering exceptional patient care.
By partnering with us for your prior authorization needs, you can benefit from our expertise in…
- Streamlining workflows
- Reducing operational cost
- Maximizing reimbursement outcome
We are committed to providing cost-effective and reliable solutions to meet the unique needs of healthcare organizations of all sizes in more than 30 specialties.
So what are you waiting for? Experience the benefits of outsourcing prior authorization services to SunKnowledge Inc. and allow us to optimize your practice while ensuring full compliance with industry standards and regulations. Our smooth transition process will help you get set up in a matter of days.
Contact us today to learn more about our prior authorization services and receive a customized solution tailored to your specific needs over a ‘no commitment’ call.
Frequently Asked Questions (FAQ)
Will you notify us if a patient's prior authorization is expiring?
Yes, we proactively monitor every prior authorization’s validity. Our team, in case of such cases, ensures the client is notified in case the patient’s authorization expires. Also, the team further makes sure-
- Renewals are initiated on time to prevent claim denials or delays.
- Regular updates are provided to the client’s team so you have complete visibility into the status of each authorization.
- We take a proactive, transparent, and customized reporting approach to ensure uninterrupted patient care and maximum revenue integrity.
Does prior authorization guarantee payment?
No, a prior authorization does not guarantee any kind of payment. It is, in fact, a process where the payer has reviewed the medical necessity of the requested service and has given a provisional approval based on the information provided at that time, which will be beneficial for the patient. Even though it is not directly related to payment, a good prior authorization expert can ensure a better ROI by providing the right and needed documentation on time, ensuring timely filing, knowing the limits, and working so there is no mismatch authorization in the prior authorization process.
Will your system work with our EHR?
Yes, our expert can work on any integrated EHR so you experience a better prior authorization operation.
What are the primary causes of authorization denials?
Most denials stem from missing clinical documentation, incorrect coding, untimely claims filing and more. While the other frequent issues include submitting requests to the wrong payer or using an outdated form. These errors however can be easily preventable with a rigorous review process or having expert like us can also make a difference.
How critical is clinical documentation for securing approvals?
Documentation is the foundation of every successful prior authorization service request. Payers require clear evidence that a treatment meets their specific medical necessity criteria. With the right physician notes and diagnostic reports, time-consuming information requests are unnecessary.
How do I stay current with evolving payer policies?
You need to regularly monitor payer newsletters and bulletins for policy updates, even sites like CMS also help. While many insurers update their PA Required lists quarterly, the best you can do is hire an expert professional like SunKnowledge.
What is the protocol if a request is denied?
If your prior authorization request receive a denial, you first need to identify the specific reason or the code provided by the payer. Once it is done, you need to fix the error and submit a corrected request or file a formal clinical appeal. Always maintain a detailed record of all communications during this process.
How can I efficiently monitor the status of requests?
A centralized tracking log or digital dashboard is the most efficient method. SunKnowledge has a transparent way of reporting daily, weekly and monthly status so you are on the same page and aware of all the PA status.
How long does prior authorization take?
At SunKnowledge Inc., we prioritize fast and accurate prior authorizations to ensure your patients receive timely care and your reimbursements stay on track. While we consistently strive for a rapid turnaround is less than 24 hours, we must not forget that the exact time frame for a prior authorization depends on multiple interrelated factors which also might affect the time frame like – complexity of the request, insurance company or TPA workload, urgency of the case, completeness of documentation, denials and appeals and of course the response time from insurance payers or Third-Party Administrators can also be the reason that varies.
What happens if my insurer denies prior authorization?
If the insurance company denies prior authorization, it will undoubtedly result in claim denials. There is a delay in prior approval, and for many patients, they might end up paying out of their pocket, which is a considerable amount. However, with our support, in case of your authorization being denied, our experts further ensure thorough review of each documentation and identify the reason for the denied authorization. Once it is done, the experts make sure all the documentation corrections & resubmission are done promptly as well. So there is a higher chance of your appeal going through this time.
How can I determine if a service requires prior approval?
The most reliable method is to check whether specific services require PA approval through the payer’s provider portal, or hire an expert like us. Requirements often change based on the patient’s plan type and the specific CPT codes involved. Always verify the latest medical policies before the service date.
What are the financial risks of delays or non-compliance?
Is it possible to submit these requests electronically?
Yes, electronic prior authorization (ePA) is the fastest submission method. Most major payers offer portals or integrations with clearinghouses for this purpose. Electronic filing provides a digital timestamp and simplifies real-time tracking.
Can the EMR system automate the authorization process?
Many modern EMR systems include modules that flag services that require authorization. While they cannot always automate the entire clinical review, they can trigger workflows. This is where dedicated resources come in handy, and SunKnowledge has a team that ensures that no required request is overlooked.
Do authorization delays interfere with physician workflows?
Yes, delays are definitely common and frequently force physicians to reschedule procedures and consults. This disruption lowers clinical efficiency and increases administrative re-work for the entire team. It takes time away from direct patient care.