Prior Authorization

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Procedure of obtaining prior approval from the payer(insurance company) before the healthcare provider offers services to the patient; Also called prior approval or pre-certification, it is a confirmation by your health insurer that a health care service, treatment plan, prescription drug or durable medical equipment is medically necessary.

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Eligibility Verification

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Validating patient’s eligibility and benefits to ensure provider receives payment for services rendered. This help healthcare providers confirm coverage prior to the office visit, preventing subsequent denials & delays in payment. It helps in saving time at back end and improving patient satisfaction.

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