The PreferredMD team of pre authorization/pre certification specialists will expertly handle the entire insurance benefits verification, pre-certification or pre-authorization process for you. Outsourcing these time consuming and arduous processes to our highly trained and experienced team allows you to focus on what really matters to your practice, delivering an outstanding patient experience.

Gone are the days when all Oxford plans pay the same.  Today’s insurance landscape contains a multitude of different reimbursement models, such as usual and customary, reasonable and customary or a percentage of Medicare fee schedules. Variables like maximum out of pocket can dramatically change the actual payout of a claim.  Keeping up with the changes in third party payers can cause an unnecessary strain on your staff. How often does your office staff have to stop important work supervising your practice or providing care, to go through training to learn a new process to remain compliant?

We offer complete prior authorization and pre certification processing, from initiation to approval. Our benefits verification system analyzes procedure-specific coverage and all out-of-pocket costs. Allowing your office staff to provide optimal experiences for all patients. If a pre-certification requires additional information, we do the research and confirm it. If required, we will communicate with the physician in question. If a pre-authorization request is denied, we will follow up with an appeal whenever possible. Your staff will be updated regularly through our secure HIPAA compliant portal.

Outsourcing prior authorizations can save your practice money. Our prior authorization specialists have a proven track record of reducing rejected claims and increasing reimbursements. Let PreferredMD take on this time consuming and arduous task. Our staff is highly credentialed and brings vast experience in verifying coverage with major insurers such as Cigna, United Healthcare, AETNA, and Blue Cross Blue Shield. 

Pre Certification  and Pre Authorization – What is the difference?

Whether a patient’s situation calls for precertification – a notification to the payer that a non urgent procedure is being considered, or preauthorization – which requires records and documentation, there are many steps that cannot be automated. Both insurance precertification and preauthorization processes require extensive knowledgeable and expertly trained staff to ensure proper processing and compliance. Furthermore, each request for additional preauthorization or precertification information requires meticulous follow-up to ensure approval before the service is provided. The expertise of the PreferredMD team ensures the prompt and efficient delivery of your prior authorizations and pre certifications. This prompt and efficient delivery facilitates your ability to provide superior patient care and diminish overhead while minimizing delays. Allowing for an optimal patient experience.   

Authorization

  • Once we’ve verified a patient’s eligibility and benefits, we determine which CPT codes require authorization. A case is opened with the payer’s insurance authorization department and securely sent,supporting clinical documentation.
  • We guarantee 24-48 hour follow-up on submission approval status.
  • Once authorization is obtained we will send you the authorization number and update the information through our portal.
  • If a request is denied, we manage the follow-up, obtain additional records or details from your office and send them to the insurance company to be reviewed as needed.
  • If a payer requests a peer-to-peer review with the physician to clarify the need for the procedure, we communicate the necessary details and coordinate a call with the payer.

Please login to submit a Pre-Authorization request.