How our company can help with pre-authorization from an insurance provider
Pre-authorization is for medical billing only. Dental does not guarantee payment on preauths and therefore we do not recommend it for dental.
Navigating the world of insurance authorizations can be a daunting and time-consuming task for any dental practice. From getting the proper documentation in order to even start the authorization process to understanding the ever-changing rules and regulations of each insurance provider, it’s no wonder that so many dental practices either don’t bother with authorizations or outsource the task to someone else.
Our company specializes in dental and medical billing services, and we are here to help your practice with the advanced job of getting a pre-authorization from an insurance provider to proceed with the operation. We understand the importance of timely and accurate submissions in order to get reimbursements, and we will work with you to ensure that all the necessary documentation is in order before we begin the process.
What is Pre-Authorization?
A decision by the health insurer or plan that a health care service, treatment plan, prescription drug or durable medical equipment is medically necessary. Sometimes called prior authorization, prior approval or precertification.
Obtaining pre-authorization can be a difficult and time-consuming process, particularly if the dental practice is not experienced in dealing with insurance companies. That’s where Elite Dental Medical Billing comes in. We are experts in getting the necessary pre-authorizations so that your practice can be reimbursed for the services provided. We will work with you to gather all of the required information and documentation and then submit it to the insurance company in a timely manner.
Why is it Necessary?
In order for a dental practice to get compensated by an insurer for providing treatment or services to a patient, a prior authorization must first be obtained. This authorization is based on the diagnosis provided by the treating dentist as well as supporting documentation such as x-rays or treatment plans. Dental practices cannot bill for services rendered without this authorization.
Pre-authorization is important because it ensures that the dental practice will be reimbursed by the insurance company for the services provided. Without pre-authorization, the dental practice may not receive payment for the services. In addition, obtaining pre-authorization gives the dental practice an opportunity to verify that the patient has coverage for the proposed treatment and to estimate the amount that will be reimbursed by the insurance company. This information can be used to provide patients with an estimate of their out-of-pocket costs prior to treatment.
What is Involved in the Process?
The first step is gathering all the necessary documentation which usually includes diagnostic information such as x-rays or treatment plans along with details about the proposed treatment. Once this information has been gathered, our team will submit it to the insurance provider for review using their proprietary system. The review process can take anywhere from a few days to a few weeks, and once it has been completed, we will let you know whether or not the treatment has been authorized. If it has not been authorized, we will work with you to determine what needs to be changed in order for us to resubmit for review.
Dental practices must obtain increasing numbers of pre-authorizations from insurance companies before proceeding with treatment. This can be a difficult and timeconsuming task. Elite Dental Medical Billing can help your practice obtain the necessary pre authorization so you can focus on what you do best – caring for your patients. We are experts in dealing with insurance companies and will work with you to gather all of the required information and documentation so that your practice can be reimbursed for the services provided. Contact us today to learn more about how we can help you!