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Utilization Management

Why Do Health Insurers Require Prior Authorization?

February 9, 2021 / admin / Articles, Healthcare, Medical Billing, Medical Credentialing, Medicare, Prior Authorization, Prior Authorization Process, Revenue, Revenue Cycle, Revenue Cycle Management, Utilization Management
Female Mulatto Doctor Prior Authorization

“This procedure will require prior authorization.” Words that no patient or healthcare provider wants to hear when they are ready to proceed with a doctor-approved procedure for a medical matter. However, it’s one of the utilization management tools that insurance companies have fostered to decide if specific prescribed procedures, services and medications are medically required […]

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Health Insurance, Healthcare, Healthcare Providers, Medical Billing, Medical Credentialing, Medical Practice, Medicare, Prior Authorization, Prior Authorization Process, Revenue, Revenue Cycle, Revenue Cycle Management, Utilization Management

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Practices Served

  • Behavioral Health
  • DME
  • Urgent Care
  • Speech Therapy
  • Geriatric Medicine
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  • Substance Abuse
  • Genetic Testing
  • Pharmacogenetic (PGx)
  • Toxicology
  • Allergy Testing
  • Oncology
  • Pathology
  • OBGYN
  • Internal Medicine
  • Biologics and Specialty Drugs
  • Telestroke and Teleneurology
  • Digital Therapeutics (DTx)
  • Remote Patient Monitoring
  • Remote Therapeutic Monitoring
  • Home Infusion Therapy
  • Sleep Study Labs
  • Physical Therapy (PT)
  • Occupational Therapy
  • COVID-19 Testing

Practices Served

  • Behavioral Health
  • DME
  • Urgent Care
  • Speech Therapy
  • Geriatric Medicine
  • Skilled Nursing Facilities (SNF)
  • Substance Abuse
  • Genetic Testing
  • Pharmacogenetic (PGx)
  • Toxicology
  • Allergy Testing
  • Oncology
  • Pathology
  • OBGYN
  • Internal Medicine
  • Biologics and Specialty Drugs
  • Telestroke and Teleneurology
  • Digital Therapeutics (DTx)
  • Remote Patient Monitoring
  • Remote Therapeutic Monitoring
  • Home Infusion Therapy
  • Sleep Study Labs
  • Physical Therapy (PT)
  • Occupational Therapy
  • COVID-19 Testing

Recent Posts

  • Payer Contract Management in Healthcare

    Payer Contract Management Strategies for Healthcare Providers

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    Credentialing Workflow Optimization

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  • White Twin Teenage Girls - CPT Codes Acne

    Which CPT Codes are Used in Acne Treatment Billing?

  • White Middle-Aged ER Physician Needing Billing

    Which CPT Codes are Used in Emergency Room Billing?

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  • New Physician Credentialing

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