Does your practice have certain procedures, medical devices and/or medications which require extra preauthorization effort?
If so, it is likely that your preauthorization requests process can be improved with detailed focus on carrier utilization management compliance. Getting the insurance carrier to provide a quality preauthorization review process starts with asking three key compliance-focused questions during the precertification inquiry period:
- Does your utilization review process comply with state and/or ERISA Claims Procedure Regulations related to pre-service claims?
- Does your utilization review process provide appeal review by a licensed professional not involved in the initial decision?
- Does your utilization review process include peer-to-peer discussion before a denial is rendered?
Tracking memos can be used to follow up on requests that don’t result in an immediate response. The tracking memos provide the patient-specific information and date and time of the request, and should quote regulatory information regarding necessity of response. Download Appeal Solutions Utilization Review Tracking Memos at AppealTraining.com
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