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To the insurer: ? Patient name, date of birth, insurance policy number, and other relevant information. ? Physician and facility information (eg, name, provider ID number, and tax ID number) ? Relevant procedure and HCPCS codes for products/services to be provided/performed.

Fighting rejections is time-consuming ?Physicians spend an enormous amount of time fighting these prior authorization rejections to get patients the therapies that they need,? said Dr. Resneck, noting in the U.S. the average doctor fills 45 such requests each week.

Pre-authorization can take a few minutes to several days, depending on the complexity of the procedure or service being requested. For example, some medical procedures may require extensive paperwork and review by an insurance provider before they are approved.

Take an active role and work closely with your doctor or the contact at your doctor's office to ensure they have the needed information. They will also need key dates for submitting the requests, so be sure to share that information as well. Identify who at your doctor's office handles prior authorizations.

Claims Processing Submit claims for services that were approved or authorized by the CCS. Claims for services without CCS approval or prior authorization may be denied.

Step 1: Check client eligibility Before filing a Prior Authorization request, ensure the patient is eligible for the proposed treatment or medicine under their insurance plan. The next step is to verify the patient's insurance coverage and any treatment or medication restrictions.

The Prior Authorization Process Flow The healthcare provider must check a health plan's policy or prescription to see if Prior Authorization is needed for the prescribed treatment. The healthcare professional must sign a Prior Authorization request form to verify the medical necessity claim.