Prior Authorization

Confirm Eligibility Before Coverage.

Begin your cost containment efforts as early as possible – through Prior Authorization. Our reviewers evaluate a patient’s specific medical situation to determine whether the service the provider recommended is eligible for coverage.

Aside from the cost savings, the service prevents inappropriate care, directs patients to a more appropriate setting, and educates providers on best practices going forward. Along with Claim Edits and Analytics, Clinical Claim Review, and Fraud Solutions, Prior Authorization can help you target improper payment.

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