As Healthcare Provider; How to Complete Insurance Pre-certification or Prior Authorization on Behalf of a Patient Instantly Online

 In Health - HIT, Patient Referrals, Pre-certification, Revenue Cycle Management

As any healthcare provider knows all to well opting Not to retain a patient pre-certification is often a mistake, ask yourself this .. would you go out and wreck your car deliberately in the event you knew you didn’t have adequate insurance?  No!  Why, because you know your then going to end up on the phone with your auto insurance company forced to explain why you choose to drive your new car into a light pole.  More than likely that conversation is going to end with the insurance provider hitting your credit card for your deductible amount.  In the event that’s not the case your going to be left with a broken vehicle and or forced to pay for the repairs out of pocket.

Interestingly, the same logic holds true in the medical space.  For those patients that simply don’t have medical insurance or in the case were the patients insurer is unwilling to cover the cost of the procedure the members doctor ordered, as healthcare facility your forced to attempt to collect the cost of the procedure from the patient in cash.  In the event the patient is unwilling to cover the cost of the procedure, your simply asked to write the medical cost off as bad debt.

Wouldn’t it be convenient to have a browser based software solution that made it convenient for a healthcare provider to submit a request for patient pre-certification aka prior authorization along with a full declaration of patient benefits in just a few seconds?

Gone are the days in which providers are forced to sit on hold to attempt to reach a insurance provider representatives, to then try to accurately convey order details, only in the hopes you’ll hear the phrase “we can approve the patient for the documented CPT code”.

Cguros has designed a full suite of tools geared towards the modern day healthcare space.  Stratus our flagship product allows providers to request full benefits analysis, current pre-certification/ prior authorization status on behalf of the patient instantly.  Inside of 15 seconds Stratus users are able to draft and execute an all-inclusive, legal medical order, with pre-certification status.  In illuminating the patient benefits declaration providers are able to determine the most lucrative means of billing for the patient (In Network provider vs. Our of Network).

When coupled with the Patient Referral Network providers are able to share patient referrals in real time with other providers.  Eliminating the need to ever again be forced to call a specialist or primary care office to request order notes, imaging results, or insurance documentation.  Everything’s included in the initial medical order, stored in perpetuity within our proprietary cloud environment.

For those providers allergic to “Another layer of tech .. ” fear not, Comeleon – our API based tool is designed around interoperability, we aim to make meaningful use a true reality.  Comeleon makes it possible for any Practice Management Solution (PM), Revenue Cycle Management (RCM), or Electronic Health Record (EHR) to adds our patient referral solution, patient benefits query capabilities along with real time acquisition of patient pre-certification status.

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