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Precertifications, also known as precerts or preauthorizations, refer to the process of getting certain medical procedures approved before being performed in order to have them reimbursed by insurance. An established pre certification company, Outsource Strategies International (OSI) provides professional pre-certification services for hospitals, outpatient facilities, and physician practices. We will manage your precerts smoothly, reducing your paperwork, and maximizing your reimbursements as you focus on patient care.
To get started with our prior authorization services, contact us at 1-800-670-2809 today!
Expert Assistance to Reduce the Complexity of Precertifications
Some private and government insurance plans require precertification of elective inpatient care as well as selected ambulatory procedures and services, diagnostic screening, and specific drugs. Failure to obtain precertifications will result in nonpayment for the services or drugs in the payer’s prior authorization list.
When a precert is submitted, the insurance company’s review and approval process will verify if:
- The procedure is medically necessary
- The plan benefits cover the service
- The service meets the insurer’s payment determination criteria
- The treatment is covered for the proposed length of stay
- The procedure/service is scheduled for concurrent review
OSI’s team of preauthorization specialists has extensive experience in documenting precertifications. They work with physicians to ensure error-free submission of the coverage request for a specific service or procedure listed on the patient’s health plan’s pre-certification list.
As insurance authorization needs to be obtained before the service is provided, we will see that all patient demographics and documentation are included, and that all procedures are carried through correctly to minimize delays and denials.
Benefits of our Prior Certification Services
- Process managed through a secure web-based portal
- Less data errors and duplication
- Verification of diagnostic and procedural codes
- Streamlined tracking of pre-certs
- Regular reports on completed authorizations and/or status updates
- Frees up physicians’ time and resources
- Fast turnaround time
- Improved patient care and satisfaction
- Enhanced reimbursements
To learn how outsourcing to our prior-certification company can simplify your precertification tasks, call 1-800-670-2809.