Patient Verification and Prior Auth Services

Streamline your revenue cycle with GM Analytics Solutions’ Prior Authorization Services, ensuring faster approvals and reducing claim denials.

Patient Verification and Prior Auth Services
Patient Verification and Prior Auth Services

Ensure timely approval for covered benefits and necessary authorizations prior to administering services.

Overview

The absence of prior authorization is a primary cause of denials in many healthcare organizations, with nearly half of all denials linked to prior authorization and other front-end revenue cycle issues. This can threaten the financial stability of healthcare organizations and negatively affect the patient’s financial experience by limiting transparency and delaying access to care.

GM Analytics Solutions specializes in creating streamlined workflows and managing standardized prior authorization processes with government and commercial payers, including Medicaid, Medicare, managed care plans, and third-party insurance. Allow us to assist you in reducing denials and optimizing your revenue.

Prior Authorization Services Provided

  • Timely Preauthorization: Ensure patients’ financial security before services by obtaining timely preauthorization.
  • Authorization Validation: Validate the necessity of authorization.
  • Referral/Authorization Submission: Initiate the submission process for referrals and authorizations.
  • Process Monitoring and Management: Monitor and manage the process, ensuring timely follow-up through to completion.
  • Proactive Outreach: Engage with physician offices and patients to resolve issues and reduce errors.

Benefits

Unlock the Benefits of Prior Authorization Services

Improve Patient Access to Care

By expediting the prior authorization process, we secure faster approvals and reduce treatment delays, improving access to necessary care and enhancing patient satisfaction.

Manage Healthcare Costs

Increase compliance and approvals through clear communication and a thorough understanding of requirements, minimizing errors and maximizing revenue.

Optimize Resources

Reduce the administrative burden on healthcare staff while effectively scaling resources to accommodate changes in volume.

Insurance Eligibility and Benefits Verification Services

Maximize reimbursements from insurance claims, prevent denials after processing, and reduce administrative workload.

Overview

Verifying a patient’s insurance coverage and benefits to determine the cost of medical treatment can be challenging due to the complexity of insurance systems and inconsistent data. Checking the patient’s insurance policy, copay, deductible, and coverage limitations often leads to staffing issues, high call volumes, and inaccurate determinations. However, identifying patient responsibility in advance is crucial for managing receivables and preventing issues with delayed payments, reworks, patient dissatisfaction, errors, and non-payment.

GM Analytics Solutions offers comprehensive insurance verification services to alleviate these challenges, allowing your staff to focus on other critical patient access services and enhancing the patient experience. Our services include insurance validation prior to appointments, determination of in-network and out-of-network benefits, and support for the No Surprises Act billing estimates for out-of-network and uninsured individuals.

Insurance Eligibility and Benefits Verification Services Provided

  • Active Coverage and Benefits Identification: Identify active third-party insurance coverage and benefits to reduce claim submission errors and back-end denials.
  • Insurance Coverage Confirmation: Confirm insurance coverage and benefits to ensure accuracy.
  • Dual- and Third-Party Insurance Eligibility: Verify eligibility for dual and third-party insurances.
  • Out-of-State Verification: Manage insurance verification for out-of-state patients.
  • Direct Payer Portal Connection: Establish direct links with payer portals to verify information in real time.

Benefits

Reduce Delays and Avoid Denials

Conducting verification checks before appointments ensures accurate, up-to-date patient insurance information. This reduces errors and denials during claims processing and increases billing accuracy.

Improved Financial Stability

A streamlined verification process with clear billing enhances the revenue cycle, ensuring timely reimbursement for healthcare services and bolstering cash flow and financial well-being.

Effective Resource Allocation

Automating processes and implementing efficient management reduces staff workload, increasing productivity and supporting patient education around financial responsibility to minimize billing disputes and ensure regulatory compliance.

 

Partner with GM Analytics Solutions to streamline your insurance eligibility and benefits verification process. Contact us today to learn more about how we can support your organization’s financial health and operational efficiency.

 

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