PRIOR AUTHORIZATION SUBMISSION & PROCESSING
Gather patient information, insurance details, and medical history for PA submissions.
Submit prior authorization requests through insurance portals, fax, or electronic prior authorization (ePA) systems.
Ensure all required documentation (e.g., imaging reports, physician notes, treatment history) is included.
TRACKING & FOLLOW-UPS
Monitor pending authorizations and proactively follow up with insurance companies.
Expedite urgent or time-sensitive requests when needed.
Keep providers and patients informed about authorization status.
HANDLING DENIALS & APPEALS
Review denied requests and coordinate with providers to gather additional documentation.
Track appeal progress and follow up until resolution.
COMMUNICATION AND COORDINATION
Communicate with physicians, medical assistant, pharmacy to ensure compliance with insurance requirements.
Provide providers/pharmacy with updates on PA status and expected processing times.
Document all PA submissions, approvals, denials, and appeals in the EHR/EMR system.
