Overview

Lack of prior authorization is consistently a top driver of denials in many healthcare organizations, as approximately half of all denials can be traced back to prior authorization and other front-end revenue cycle issues. This can jeopardize the financial health of a healthcare organization and negatively impact the patient’s financial experience by limiting transparency and delaying access to care.

AGS Health specializes in implementing streamlined workflows and managing standardized prior authorization processes with government and commercial payers, such as Medicaid, Medicare, managed care plans, and third-party insurance. Let us help you minimize denials and maximize your revenue.

Prior Authorization Overview
Prior Authorization Services Provided

SERVICES PROVIDED

  • Validate the necessity of authorization.
  • Initiate submission of referral/authorization.
  • Monitor and manage the process and timely follow-up through to completion.
  • Proactive outreach with physician offices and patients to resolve issues and reduce errors.

BENEFITS

Expedite the prior authorization process for faster approvals and reduce treatment delays to improve access to necessary care and enhance patient satisfaction.

Increase compliance and approvals through clear communication and knowledge of requirements to minimize errors and maximize revenue.

Minimize the administrative workload on healthcare staff while effectively scaling resources to changes in volumes.

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Insurance Eligibility And Benefits Verification

Identify active third-party insurance coverage and benefits to reduce claim submission errors and back-end denials.

Patient Payment Estimation

Prepare for patient conversations on financial responsibility by collecting accurate good faith estimates.

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Secure pre-service collections and patient education on estimated financial liability and payment options.

Resources

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When you create a high-performance revenue cycle, you’re finally free to invest your full resources into what matters most: the care of your patients.

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