Prior Authorization / Pre-Certification Management Services

Our 360-degree Prior Authorization/Pre-Cert Approach

Prime Care Health Solutions secure, HIPAA-compliant Prior authorization and precertification management service simplifies the entire prior authorization (PA) pre-certification process, saving physicians, pharmacists and other healthcare providers’ valuable time, and ensuring patients receive their medication and equipment faster.

Our Pre-Certification Process

The initial step should be one your staff already takes daily. Start by entering the appropriate patient information along with diagnosis and fee codes into our online PA/Pre-Cert authorization request form. This shouldn’t bring about any major shifts in processes since your intake staff already collect and record all the pertinent information for each patient. This will start the precert process, and one of our knowledgeable staff will take over managing the process from start to finish. If the patient’s insurance provider needs additional information or needs to speak with a physician at your practice, we’ll be sure to keep you informed to keep the process moving forward.

Once approval is acquired, we’ll complete any action items and handle the required data entry. If the request isn’t approved, we’ll handle the follow-up and appeals.

What we do

  • Gathering of vital information
  • Check the patient's eligibility
  • Communicate and validate prior authorization request with the payers
  • Initiate PA requests as per the payer protocol
  • Follow up with payer for checking the authorization status
  • Follow up ordering physician for the additional documents as requested by the payer
  • Provide the additional information as requested by the payer
  • Provide updates regarding the authorization outcome
  • Service at affordable hourly rate or pay per PA/Pre-cert case. Our service includes a dedicated account manager
  • We apply network-based knowledge about prior authorizations to your practice in real time.
  • Reduce Duplication and data errors
  • Focus more on patients and less on paperwork
  • Maximize Claim reimbursements
  • Our prior authorization specialists submit documentation on your behalf and work with payers to approve your requests.
  • We have exceptional success rate obtaining authorizations of requests
  • Most authorizations are delivered with zero client work
  • Almost all authorizations are started and completed within one week
  • Our team combines with all leading practice management systems and offers a streamlined assistance in prior authorization

Our process, simplified

  • Patient Eligibility Verification
  • Customized Verification Process
  • HIPAA-compliant Insurance Verification and Authorization Solutions
  • Complete prior authorization processing, from initiation to approval.
  • If a pre-cert needs more information, we will do what we can to track it down or arrange for a call with the physician in question.
  • If a pre-authorization request is denied, we will follow up with an appeal whenever possible.
  • We provide you with regular PA-Pre-Cert status updates
  • Our pre-cert team keeps up to date with training to stay in compliance.
  • A dedicated PA-Pre-Certification team means fewer requests falling through the cracks and a more streamlined billing system — which means a better bottom line for your practice.
  • Extremely Affordable with Fast Turn around Time
  • STAT Service
  • No Long Term Contracts
  • Work in your System - Work as an Extension to your Practice
  • We are Experts in almost all Specialties
  • Avoid patient care delays, claim denials and appeals!
  • Accurate verification of co-pays, deductibles, payable benefits and more!