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Type of authorizations we handle

  • Inpatient and outpatient surgeries and procedures

  • Referral and E&M-based submissions

  • Therapy, rehab, and other service-based submissions

  • Implant and orthodontics procedures

  • Injections, infusions & specialty medication

  • Standard, genetic and molecular labs

  • Radiology, diagnostics, ultrasound scans and more

  • Durable medical equipment (DME)

  • New consult visits to specialty providers

What we do

  • Confirm active patient coverage

  • Effective coverage dates

  • Maximums and deductibles

  • Confirm benefits used to date

  • Initiate insurance prior-authorization requests

  • Track each request to approval

  • Provide regular updates through our secure, HIPAA-compliant portal

  • Ensure verifications of eligibility and pre-cert authorizations are completed in a timely manner and prior to any upcoming scheduled visits

  • Maintain compliance with staff training requirements

A dedicated pre-certification team means fewer requests falling through the cracks and a streamlined billing system. An in-house verification team is costly, but our cost is lower than hiring an in-house verification team– which means a better bottom line for your practice.
 

We expertly handle the pre-cert process from start to finish. If a pre-cert requires additional information, we track it down or arrange for a call with the ordering provider. With Access Health, you will have an experienced professional on your side.

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HIPPA

Compliant

Insurance authorizations services

One of the most difficult and time-consuming tasks that medical professionals face is eligibility verification and the in-depth process of obtaining prior authorizations. It’s a laborious, challenging, and expensive process which consumes so much of your office's time and resources. Because of this, Access Health is ready to meet specific needs that may be requested in each authorization.

 

According to the AMA press release in Feb 2022, physicians report prior authorization hurts workforce productivity. “According to the AMA survey, more than half (51%) of physicians who care for patients in the workforce reported that prior authorization had interfered with a patient’s job responsibilities. In fact, more than one-third (34%) of physicians reported that prior authorization led to a serious adverse event, such as hospitalization, disability, or even death, for a patient in their care. Also, more than nine in 10 physicians (93%) reported care delays while waiting for health insurers to authorize necessary care, and more than four in five physicians (82%) said patients abandon treatment due to authorization struggles with health insurers.”

The prior authorization process affects the stress levels of the staff working the requests, but patients who are awaiting much needed care. Having Access Health as an extension of your Primary care practice, Specialty practice, or Dental office gives you advantages; it saves you time and money, and eliminates burden in your administrative team. Whether you’re scheduling a procedure 45 days out or seeking a STAT turnaround time, we can do the job.

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Our pre-certification process

The process is very simple, your office staff will receive the order from the physician. This order could be for a procedure, surgery, imagine or a DME request. Your team documents and enters the diagnosis and CPT codes into your authorization system. This will start the pre-cert process and initiates our team’s process; from there, one of our experienced authorization coordinators will take over and will manage the process from start to finish.

 

If the patient’s insurance provider needs additional information or needs to speak with a physician at your practice, we’ll be sure to keep you informed to keep the process moving forward. Once an approval is received, we’ll complete any action items and enter the authorization details into your EMR system. If the request isn’t approved, we’ll provide options for peer to peer reviews, appeals, and other avenues to ensure a positive outcome. Our team will follow up with the insurance company, as frequently as necessary, to ensure the authorization is approved quickly.

  • Why Access Health to help with your prior authorizations?
    Access Health can help streamline and simplify the prior authorization process by providing experienced and knowledgeable staff to handle authorization requests. Our team is well-versed in the authorization process and is familiar with the different requirements and regulations associated with the authorization process. We have the expertise to ensure that authorization requests are completed quickly and accurately, and our team can assist in making sure that all documentation is properly submitted. With Access Health, you can rest assured that your authorization requests will be handled in a timely and professional manner.
  • How long does it take to process a medical authorization request?
    Our team will submit an authorization request to the Insurance company within 24hrs received. If there’s a STAT (same day) or urgent request, we would request a phone call to our authorization coordinator to let us know about the urgent request. We always strive to provide the most accurate and up-to-date information.
  • What happens if an authorization is denied?
    If an authorization request is denied by the insurance company, Access Health will notify office staff of the denial. With this information, our team will assist the provider with an appeal to provide updated information on why medical necessity was not met and how you can provide new supporting documents.
  • What is a prior authorization?
    Prior authorization (PA) is any process by which physicians and other health care providers must obtain advance approval from a health plan before a specific procedure, service, device, supply, or medication is delivered to the patient to qualify for payment coverage. Other terms used by health plans for this process include “preauthorization,” “precertification,” “prior approval,” “prior notification,” “prospective review” and “prior review.”
  • Why outsource prior authorizations?
    Outsourcing prior authorizations can help reduce administrative costs and help ensure that the authorization process is properly managed. By outsourcing prior authorizations, healthcare providers can save time, money, and resources. Additionally, outsourcing prior authorizations can help reduce the risk of errors, ensure compliance with regulations and policies, and improve the accuracy and speed of the authorization process.
  • How long does it take to input data?
    We provide a quick response for our data entry service and guarantee a turnaround time of 24 hours in most cases. However, the project turnaround time will also depend on the volume of work, project complexity, and urgency.
  • Can you customize your data entry services to meet my specific needs?
    Yes, we can work with you to customize our data entry services to meet your specific requirements and business needs.
  • How do you ensure the quality of your data entry services?
    We follow strict quality assurance processes to make sure that we deliver high quality data entry services to our customers.
  • How do you ensure the accuracy and security of the data you enter?
    We have strict quality control measures in place to ensure the accuracy of the data we enter. We also use secure data transfer and storage methods to protect sensitive information.
  • What is data entry?
    Data entry is the process of inputting information into a computer or other electronic system, typically by typing it in using a keyboard or other input device. This can include entering numerical data, text, or other types of information, depending on the specific application. Data entry is often used in a variety of industries, including business, healthcare, and government, to maintain records, process transactions, and perform other tasks.
  • Do you offer call recording?
    Yes, all our calls are recorded. Calls are available to you whenever you need them.
  • Are you based in the United States?
    Yes, we are based in California.
  • Are your agents bilingual?
    Yes, our agents are fluent in English and Spanish.
  • Can you customize your contact center services to meet my specific needs?
    Yes, we can work with you to customize our contact center services to meet your specific requirements and business needs.
  • What is healthcare contact center outsourcing?
    This type of outsourcing involves an entity that handles protected health information (PHI) contracting with a third party to answer inbound calls. Healthcare contact center outsourcing is one of many forms of business process outsourcing (BPO). We act as an extension of your organization and provide services that comply with the health insurance portability and accountability act (HIPAA).
  • How do you ensure the quality of the services your agents provide?
    We have strict quality control measures in place to ensure that our agents provide high-quality services. This includes regular training and performance evaluations.
  • How long does it take to set up a contact center for my office?
    The length of time it takes to set up a contact center for your business will vary depending on the size and complexity of the project. We will provide you with a project timeline after assessing your specific needs.
  • Why do I need healthcare contact center outsourcing?
    Customer support has become an integral aspect of the current healthcare landscape, playing a major role in patient retention and referrals. Our healthcare customer support services will empower your business to offer superior patient care through human engagements and top-quality treatments. This will significantly boost customer relations and improve brand loyalty.
  • Are Medical contact centers the next cost-saving measure for the healthcare industry?
    They are a powerful cost saving measure, but that’s far from their only benefit. They save time, hassle, and help your organization do what it does best: serve your community. It’s a must for any healthcare organization that is serious about optimizing their operation.
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  • How does Access Health ensure HIPAA - compliant practices?
    All messages can only be accessed through a secure login to guarantee confidentiality, and are only accessed by trained agents, handling the periodic change of passwords as a rule.
  • Will my patients health information be used to sell goods and services?
    No. All personal health information will be protected, and no information will be given to any third party.
  • How are Access Health agents trained in HIPAA compliance?
    All of our agents are trained and certified in HIPAA protocols. Our team completes multiple training courses in call handling practices, so they know how to correctly process any sensitive patient information.
  • What is HIPAA?
    The Health Insurance Portability and Accountability Act of 1996 (HIPAA) was created to protect sensitive patient health information from being shared without patient knowledge or consent. HIPAA requires healthcare organizations to store patient information in a format that is secure from data breaches and accessible only to appropriate individuals. The HIPAA Privacy Rule gives patients more control over their health information and set boundaries on the use and release of health records. As a BPO, we maintain compliance with the HIPAA Privacy Rule and support you in caring for your patients. You can read more about the HIPAA Privacy Rule here: https://www.hhs.gov/hipaa/for-individuals/faq/187/what-does-the-hipaa-privacy-rule-do/index.html
  • I have more questions regarding Access Health HIPAA compliance. Can you help?
    Yes! We are available. Call us at xxxxx
  • What type of encryption is used to ensure security?
    Encryption is based on the data being retrieved or stored. We utilize the RSA-2048 (asymmetric) and AES-256 encryptions methods. All data is encrypted and transported via HTTPS/SSL from the customer’s premises to the cloud platform for processing and storage.
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