If you're a doctor or physician, you may be handling PAs yourself. While this can be a great way to save money, it also comes with risks.
In this blog post, we will discuss the role of prior authorizations in healthcare and how you can best utilize them in your own practice. PAs are an important part of the medical community and can play a vital role in patient care, so it's important to know how to work with them.
Insurance companies use prior authorization to determine if a prescribed product or service will be covered. Prior authorizations are a necessary step in the process to ensure your health plan will cover any services or prescriptions you receive.
In order for prior authorization approval, there must be an interaction with patients (and their doctors), healthcare professionals who treat them and insurance companies whose coverage they have purchased from - this includes anyone involved when it comes time for treatment.
How Prior Authorization Works
Health plans require prior authorization for certain procedures, and if you don't get it then your claim can be rejected.
This means that each plan has its own set of rules about when a medical necessity is required before they'll cover the cost. Generally speaking, the more expensive an item or service requested by patients in relation to their annual income level (based on guidelines set out by CMS), the more likely that there will be some sort-of diligence with regards to how much time needs lapsed since last coverage occurred.
Why Prior Authorization is a Headache
Prior authorization is a constant source of stress for doctors, patients and health plans. On average, practices complete 41 prior authorizations per physician each week, which can take up to 13 hours to process.
The delayed access causes tension in all aspects including relationship building with clients as well as scheduling appointments. This also delays patients in receiving the treatment they need and sometimes causes them to ignore treatment all together.
This can create problems for everyone involved: patients who need care soonest, doctors trying dealing with prior requests and new ones too, all while being stuck in an endless cycle of paperwork.
Senderra Handles Prior Authorization for You
Senderra is the leader in the Specialty Pharmacy industry and offers customers an innovative solution to streamline day-to-day operations.
Senderra provides physicians with access to comprehensive information about patients as well as prescriptions necessary for therapeutic care through its proprietary Physician Portal platform. The Physician Portal platform not only simplifies tasks, but also increases productivity by removing time consuming administrative duties from doctors’ and physicians' plates.
Why Choose Senderra?
The combination of our trained team of patient care and clinical specialists, our proprietary technology and our high-touch, partner-focused protocols ensure better outcomes and a better, streamlined process for your clinic.
Ask a Senderra representative for more information on our Specialty Pharmacy services.