Pearls for Preauthorization

Over the next several months, “From the College” will offer practical tips on improving office management guidelines, putting the latest healthcare information technology to work for you, and coding. This month, “From the College” offers some pearls for preauthorization.

Health plans often deny or return preauthorization requests because of missing data. Physician practices can avoid this by ensuring that preauthorization requests include accurate patient information by:

1. Sending all chart notes, lab values, and radiology results, as clinically appropriate, with the initial preauthorization form;
2. Always asking the name of the person with whom you’re speaking and noting that along with the date and time of the phone call to avoid receiving conflicting information;
3. Obtaining clinical evidence noting the efficacy of medication for a particular diagnosis;
4. Keeping copies of all communication between insurer and provider, because authorizations sometimes get misplaced; and
5. For annual preauthorizations, using a previous authorization with a new date and chart notes.

Next month, “From the College” will cover practical tips for preauthorizations for specific drugs and procedures. If you have questions or wish to submit practice pearls for consideration to appear in “From the College” contact Antanya Chung at [email protected]