What is Pre-Authorization In Medical?

A decision by the health insurer or plan that a health care service, treatment plan, prescription drug or durable medical equipment is medically necessary. Sometimes it is called prior authorization, prior approval or precertification.

Obtaining pre-authorization can be a difficult and time-consuming process, particularly if the dental practice is not experienced in dealing with insurance companies. That’s where Elite Dental Medical Billing comes in. We are experts in getting the necessary pre-authorizations so that your practice can be reimbursed for the services provided. We will work with you to gather all of the required information and documentation and then submit it to the insurance company in a timely manner.

Why is it Necessary?

In order for dental practice to get compensated by an insurer for providing treatment or services to a patient, prior authorization must first be obtained. This authorization is based on the diagnosis provided by the treating dentist as well as supporting documentation such as x-rays or treatment plans. Dental practices cannot be billed for services rendered without this authorization.

Pre-authorization is important because it ensures that the dental practice will be reimbursed by the insurance company for the services provided. Without pre-authorization, the dental practice may not receive payment for the services. In addition, obtaining pre-authorization gives the dental practice an opportunity to verify that the patient has coverage for the proposed treatment and to estimate the amount that will be reimbursed by the insurance company. This information can be used to provide patients with an estimate of their out-of-pocket costs prior to treatment.

What is Involved in the Process?

The first step is gathering all the necessary documentation which usually includes diagnostic information such as x-rays or treatment plans along with details about the proposed treatment. Once this information has been gathered, our team will submit it to the insurance provider for review using their proprietary system. The review process can take anywhere from a few days to a few weeks, and once it has been completed, we will let you know whether or not the treatment has been authorized. If it has not been authorized, we will work with you to determine what needs to be changed in order for us to submit it for review.

Dental practices must obtain increasing numbers of pre-authorizations from insurance companies before proceeding with treatment. This can be a difficult and time-consuming task.

Check the medical plan before you do any billing either with Availity on line or on the phone.

If you want to bill many medical plans the best thing to do is sign up with Gary to become a certified Radiology Office.

You can contact ctaxin@links2success.biz or go to www.dentalmedicalbilling.com and look at the web program on the site with Radsite to look into your new business adventure.