PRIOR AUTHORIZATION . . . knowing where you stand.
The relationship between prior authorization, or Concurrent Utilization Review and billing is essential to maintaining cash flow. Keeping track of days or services authorized, knowing that services are certified, and a means of integrating authorizations to billing is a key facet of MEDIK—a feature that increases revenue, minimizes denials and promotes efficient treatment planning.
The MEDIK prior authorization feature permits paperless tracking of interactions between providers and payers. The services authorized and authorization number are linked to patients' accounts and subsequently to billing forms and functions.
Bills can then be generated as required by the payer, for example in authorization spans or other prescribed billing frequencies.
Different types of authorizations with different characteristics are available such as days authorized, individual services allowed, Primary Care Physician authorizations or authorizations based upon the frequency of services. RSPMI and other Medicaid and managed care providers requirements are fulfilled. In short, we connect the business office to utilization review.
The Prior Authorization feature also addresses denied services and the capacity to manage appeals. Ultimately facilities and practices can correlate denials to specific payers, managed care organizations, physicians, levels of care and dozens of other factors to discern the trends and circumstances that result in denied days and dollars. Users can also track overturned denials to measure the success of appeals.