Services
Clinical Prior Authorization Services
Overview
Clinical authorization is a requirement from health insurance companies to ensure procedures and treatments are medically necessary, and healthcare organizations are facing significant administrative and clinical challenges to obtain prior authorization from payers for inpatient and outpatient services. Services that require clinical authorizations include:
- Elective surgeries (non-emergency)
- Oncology (chemotherapy) services
- Infusions and other therapies
- Experimental and investigational services
- High-cost drugs and devices
We help you secure clinical authorizations for complex medical cases, including prior authorizations (prospective) and concurrent authorizations, to ensure proper reimbursement and timely delivery of care aligned to payer contracts. Sharing clinical information to support the medical necessity required to obtain authorizations is an imperative part of the process to mitigate denials.
SERVICES PROVIDED
AGS Health provides seasoned, experienced resources to support clinical authorizations. Clinical prior authorization services provided include:
- Eliminating backlogs of pending authorizations
- Monitoring communication between providers and payers
- Concurrent authorization
- Providing necessary medical codes
- Faxing services
- Peer to peer review
BENEFITS
Proper Reimbursement
Streamline processes to close communication gaps between providers and payers to maximize revenue cycle efficiency for accurate reimbursement.
Mitigate Denials
Reduce errors that can lead to denials and resubmissions, minimizing the financial strain caused by denied claims.
Timely Delivery of Care
Ensure services are aligned with payer contracts to ensure patients receive necessary treatments and optimized care plans without unnecessary delays.
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Additional Clinical Administrative Services to streamline your revenue cycle
Clinical Documentation Integrity Services
A combination of retrospective, prospective, and concurrent reviews of clinical documentation provides precision and specificity in clinical documentation tailored to inpatient and ambulatory settings.
Utilization Management Services
Provide appropriate, efficient, and cost-effective care consistent with current medical standards, preventing unnecessary procedures and optimizing treatment plans to enhance patient outcomes, streamline resource utilization, and drive healthcare excellence.
Clinical Denials and Appeals
Review denied claims to identify root causes, and craft compelling appeals supported by comprehensive clinical evidence to maximize revenue and minimize financial losses.
Physician Advisory Services
Skilled physicians and healthcare professionals provide customized solutions to optimize clinical documentation, coding accuracy, and revenue integrity.
Resources
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