Referral submission & tracking

For Specialists who requires a referral or a pre-authorization form the process starts with retrieving the patient demographic information, insurance coverage, procedures to be authorized, and details of the provider to which they will be referred.

Our Precertification service complements Eligibility and Benefits verification. Certain Referrals and Prior Authorizations are required by the patients' health insurance plans.

The precertification team provides protocols for patient services requiring precertification. The protocols include the patient demographic information, insurance coverage, procedures to be authorized and details of the provider to whom they will be referred.

Once the referral is submitted tracking will be done to insure that the patient will be authorized to see the specialist on their designated appointment. This service also allows for emergency referrals on the date of service as needed by the office.  A major advantage of pre-certification is the decrease in denials for non-authorized care thereby leading to reduction in bad debts.