Authorization & Referral Management

Authorization & Referral Management

The healthcare realm is facing, most common denial in medical billing reimbursement rates as Pre-Authorization, Prior Authorization, Pre-Certification, and Notification. Authorization is the process of getting a medical service(s) authorized from the insurance carrier. Providers or Medical billing companies have to contact insurers in advance and obtain a certification number in order to be reimbursed properly. The process of obtaining Referrals from a primary care physician before seeing a specialist. These processes result in an authorization and referral number and provider’s/billing companies must use on claims submitted for payment.


Our Authorization and Referral Process:

CareClaimz is well aware of the Authorization and Referral process. We consider and manage it as a special project in Medical Billing Cycle because of the time and costs associated with it. Our Authorization Specialists have wide-range knowledge of functionalities and compliance with payer contractual requirements. We identify, verifying eligibility, obtaining insurance benefits, and ensuring pre-certification, authorization, and referral requirements through in all paperwork and research relevant to each case from the payer carriers. We Obtained prior authorizations and referrals from various payer carriers by submitting clinical information via fax and online payers web portals or by speaking directly to a case management representative. We ensure end to end, timely, and accurate submission of prior and retro authorization and referral requests to the payers. it is our pledge to make everyone aware of any changes or implementations that may potentially impact you financially growth.

Submission of Pre-Authorization and Referral Request:

We require following information:
  • Demographic information of the patient
  • Patient Full Name
  • Date of Birth
  • Insurance ID
  • Tax ID number
  • National Provider Identifier (NPI) number
  • Address where services are being provided
  • Phone and fax number
  • CPT/HCPCS codes
  • Diagnosis Code
  • Location where the service will be performed
  • PCP Information
  • Specialist Information