Pre-authorizations And Eligibility Of Benefits
- Verification and eligibility of all in-network and out of network benefits
- Pre-authorizations start with assigning the appropriate code(s)
- Knowledge of what clinical information insurance carriers need upon submission
- Obtain Retro-authorizations
- Obtain PIP ledgers to make sure there are sufficient funds on the policy to proceed with further treatment
- Verify if patient chose their health insurance as the primary option on the policy
- Knowledge of the internal appeal process for No Fault (PIP) claims
- Interpretation of DOBI Rules on PIP reimbursements
- Pre-authorization of Workman’s Compensation claims including knowledge of completion of the C4 form
- Home Infusion authorizations – Alliance will inquire how many per diem visits, and their maximum limits allowed per year
- Nursing visits, and refills for each specific medication that needs to be authorized along with the number of units allowed
- Verification of ICD-10 codes and CPT codes including quantities and units needed
- Monitoring of existing preauthorization expiration dates for processing of continued services
- DME services will be authorized and verified
- Pharmacy pre-authorizations – If the preauthorization needs to be initiated by the M.D., Alliance can collect all pertinent paperwork from insurance and/or the physician’s office to be completed
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