Prior Authorization / Pre-Certification Management Services

About PA/Pre-Cert Management

Prime Care Health Solutions allows our clients to leave the time consuming, burdensome and frustrating process of prior-authorizations behind. We understand that prior-authorizations can pose an expensive operational cost to many medical practices which can halt revenue streams and cripple turnaround time for treatment and prescription medications.

The American Medical Association (AMA) reports that prior-authorization/pre-certifications consumes approximately 1 hour of physician time, 13.1 hours of nurse time, and 6.3 hours of clerical time per week. This translates to 853 hours per year of staff time, which is a cost of $82,975 in labor annually per full-time physician.

Let us help you offer the highest levels of patient care by expediting your prior authorization process with Prime Care Health Solutions. Let us take those time-consuming tasks off your plate, and free you up for the work that matters most. Our service streamlines the processing time and simplifies the overall prior authorization workflow in order to get your patients the prescription medication and medical services they need as quickly as possible.

Our prior-authorization/pre-certification management services help clients stay focused on patients and patient care. Prime Care Health Solutions prior-authorization management services, facilitates prior authorization and pre–certification process between healthcare providers and their payers.

Why Outsource with Prime Care Health Solutions?

Prime Care Health Solutions understands that outsourcing your business to us is a major decision and we want to help you make the best decision possible for your business. That is why we have solution managers who can help you to make that difficult decision by going over the different aspects of your business and helping you to find the right solution.

Our experienced staff works in partnership with physician offices and insurance payers, ensuring comprehensive management of your prior authorization/ pre-certification cases for hospitals, outpatient facilities, physician offices and many more. Please contact us for a no obligation free consultation by one of our solutions manager. We want you to be satisfied in knowing that Prime Care Health Solutions will deliver the best service and most competitive pricing available.
Our aim is to liberate healthcare personnel from the acute demands of prior authorization, and find more time and peace of mind to concentrate on actual patient care. We accomplish this by consistently delivering the best support to our clients for getting prior authorizations/pre-certification completed quickly, accurately and cost-effectively.

We help healthcare practices of all shapes and sizes cut cost, boost revenue and earn massive collections from insurance claims. We also work with Insurance payers in adjudicating claims. Our teams of specialist have years of experience backed with superior knowledge of the industry that helps get claims reviewed and approved sooner and faster!

Outsourcing comes with incredible advantages

  • SAVE TIME & MONEY: Our service eliminates much of the burden on your administrative staff allowing you to better utilize staff resources for patient care
  • PROVEN EXPERTISE:  Our staff has years of experience successfully handling prior authorization to give you the best service results.
  • FAST RESOLUTION: Our prior authorization experts are well-versed in the ins and outs of the process.  The result? Faster prior authorization resolutions
  • UNIQUE INSIGHT: Our years of experience working with major Insurance payers, along with our years of experience in adjudicating claims, has given us a deep understanding of the prior authorization process. This is clearly reflected in our high success rate with prior-authorization/ pre-certification cases.
  • FLEXIBILITY: We don’t have binding contracts. Feel free to cancel anytime. You can also work in small bursts, or opt for bulk requests – short-term or long-term.
  • HIPAA COMPLIANCE: Our operations are 100% HIPAA compliant
  • SECURE TRANSACTIONS: Every piece of data exchanged between Prime Care Health Solutions and our clients are secure.

Additional benefits of outsourcing PA/Pre-Cert with Prime Care Health Solutions

  • Focus on Patients, and Not PaperworkWhen fewer of your internal resources are focused on medical prior authorizations, this frees you to spend more time doing what you and your staff do best – delivering exceptional patient experiences.
  • Reduce Billing Errors
    Prime Care Health Solutions prior authorization specialists are trained and equipped with the knowledge that they need to get the right authorizations for your practice, helping to reduce rejected claims and increase reimbursements.
  • Save more money
    Outsourcing medical prior authorizations with Prime Care Health Solutions can actually save your practice money. Less overhead, less ongoing training, and fewer resources tied up in administrative processes. We offer quality affordable service that will help reduce billing errors and improve patient outcomes. Our clients pay only for the number of authorizations needed at no minimum order volume.
  • Take back time
    Fewer patients showing up for appointments without authorizations means a more manageable schedule, improved access to timely care, and better–utilized staff hours.
  • Improve Patient Experience
    Lessened administrative burdens mean more time to greet patients when they walk through the door or answer their questions on the phone — and delivering the care your patients know and trust.
  • Ensure Billing Compliance
    It’s a full-time job to keep up with the changes in Medicare, Medicaid, and third-party payers. But Prime Care Health Solutions has made it our job to stay on top of those changes for you, so that you remain in compliance without worry.
  • Grow the Bottom Line
    Efficient and accurate prior authorization processes do more than reduce costs; they improve payment cycles and reimbursements, all resulting in a healthier bottom line.
  • Minimize paperwork
    Prime Care Health Solutions securely and electronically handles PA requests, eliminating the need for hand-written forms or calls to the plan. PA/Pre-Cert requests are also accepted via website through online PA/Pre-Cert request form or via e-fax, eliminating the need for bulky paper-based orders or waiting for days, if not weeks.
  • Better accuracy
    Experience the highest PA/Pre-Cert processing accuracy as we handle all your PA requests with professional care and speed. We can increase the number of successful authorizations you receive.

Our 360-degree Prior Authorization/Pre-Cert Approach

The initial step should be one your staff already takes daily. Start by entering the appropriate patient information along with diagnosis and fee codes into our online PA/Pre-Cert authorization request form. This shouldn’t bring about any major shifts in processes since your intake staff already collect and record all the pertinent information for each patient. This will start the precert process, and one of our knowledgeable staff will take over managing the process from start to finish. If the patient’s insurance provider needs additional information or needs to speak with a physician at your practice, we’ll be sure to keep you informed to keep the process moving forward.

Once approval is acquired, we’ll complete any action items and handle the required data entry. If the request isn’t approved, we’ll handle the follow-up and appeals.

Our process

  • Gathering of vital information
  • Check the patient’s eligibility
  • Communicate and validate prior authorization request with the payers
  • Initiate PA requests as per the payer protocol
  • Follow up with payer for checking the authorization status
  • Follow up ordering physician for the additional documents as requested by the payer
  • Provide the additional information as requested by the payer
  • Provide updates regarding the authorization outcome
  • Service at affordable hourly rate or pay per PA/Pre-cert case. Our service includes a dedicated account manager
  • We apply network-based knowledge about prior authorizations to your practice in real time.
  • Reduce Duplication and data errors
  • Focus more on patients and less on paperwork
  • Maximize Claim reimbursements
  • Our prior authorization specialists submit documentation on your behalf and work with payers to approve your requests.
  • We have exceptional success rate obtaining authorizations of requests
  • Most authorizations are delivered with zero client work
  • Almost all authorizations are started and completed within one week
  • Our team combines with all leading practice management systems and offers a streamlined assistance in prior authorization

Our PA-Pre-Cert Process, Simplified

Prime Care Health Solutions secure, HIPAA-compliant Prior authorization and precertification management service simplifies the entire prior authorization (PA) pre-certification process, saving physicians, pharmacists and other healthcare providers’ valuable time, and ensuring patients receive their medication and equipment faster.

Patient Eligibility Verification

Customized Verification Process

HIPAA-compliant Insurance Verification and Authorization Solutions!

Complete prior authorization processing, from initiation to approval.

If a pre-cert needs more information, we will do what we can to track it down or arrange for a call with the physician in question.

If a pre-authorization request is denied, we will follow up with an appeal whenever possible.

We provide you with regular PA-Pre-Cert status updates

Our pre-cert team keeps up to date with training to stay in compliance.

A dedicated PA-Pre-Certification team means fewer requests falling through the cracks and a more streamlined billing system — which means a better bottom line for your practice.

Extremely Affordable with Fast Turn around Time

STAT Service

No Long Term Contracts

Work in your System – Work as an Extension to your Practice

We are Experts in almost all Specialties

 Avoid patient care delays, claim denials and appeals! Accurate verification of co-pays, deductibles, payable benefits and more!

Our Clients

Our prior authorization and pre-certification management services are designed to be used primarily by Providers and pharmacists who want to simplify their prior authorization process, by making them faster, more efficient and accurate and reduce administrative staff workload. However, any practice – big or small – in need of professional prior authorization assistance, can get in touch with us. Our clients include:

We can be trusted to provide end to end management of your prior authorization/pre-certification needs across a wide range of specialties that includes pre authorization services for:

    • Orthotics and Prosthetics
    • Radiology
    • Image Centers
    • Genomic Lab Prior Authorization
    • DME Manufacturers and Sellers
    • Nursing Homes
    • Dermatology
    • Anesthesiology
    • Podiatric Medicine
    • Specialty Pharmacy
    • Hospitals

Prior Authorization (PA) Management Initial Request Form

Contact us @214-613-2019 or complete the form below to request management of a prior authorization/pre-certification request.

A Prime Care Health Solutions team member will contact you to complete your request.