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.
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.
Collection of patient information and consent required for the medical record in order to meet established clinical, financial and regulatory demands.