In this video, Mohammed Ahmed, Availity’s Vice President of Authorization Sales Enablement, discusses the three key steps of a prior authorization process. He explains these three steps as: determination, submission, and status. Step One, Determination: We determine if an authorization is required from the payer for a given procedure. An automated solution should use a sophisticated rules engine to automatically determine if a procedure is required. The solution should be very fast and deliver high-quality results. Step Two, Submissions: A solution should automatically connect to the right payer portal and automate most of the submission process. Step Three, Status: The solution should check the status of the authorization frequently and automatically. When it’s approved, it should be sent back to the EHR or RIS system. There should be no need for a pre-certification specialist to have to get involved in checking status. In summary, an automated authorization solution should automate a majority of these three steps for a majority of the payers.
Dr. Greg Zydiak reviews tactics he's developed for fighting back against insurance company red tape. See Dr. Zydiak's form, Physician Consult Request for Prior Authorization Information Research and Transmittal: https://www.scribd.com/doc/297534113. Copy of court decision referenced in video: https://goo.gl/nwbxJs
Watch this video to learn the simple steps of the prior authorization process.
Advice from a person on the other side of the pharmacy counter. This video's topic: prior authorization/prior approval. Have you ever tried to fill a prescription at a retail pharmacy and be told it couldn't be filled due to it needing a prior authorization or a prior approval? Were you confused about it or did you not understand it? This video will explain what is meant by the term.