HIPAA Compliant Prior Authorization Outsourcing Services

Outsource Your Prior Authorization

Our experienced prior authorization team works to save time and reduce denials.

Prior authorization is critical for many patients and healthcare treatments. While emergency services and many day-to-day medical treatments are insurance-authorized after the service, other procedures require preapproval from the insurance provider.

Global Healthcare Resource understands the complexities of prior authorization paperwork, and our services have helped healthcare organizations better serve their communities for over 25 years. Discover how we can help your patients get necessary care faster.

Our Prior Authorization Services

Our experienced prior authorization team works efficiently and meticulously to complete:

Coverage analysis: We evaluate your patients' policies and assess which treatments or procedures will require prior authorization.
By-case analysis: As patient and provider requests come through, we determine whether they should be submitted to insurance before or after care administration.
Timely documentation: Where prior authorization is necessary, we complete and submit the required paperwork efficiently, meeting all submission deadlines.
Consistent follow-up: We continue to monitor each case following submission, addressing challenges as they arise and ensuring each request moves on schedule.

Why Outsource Prior Authorization?

Outsourcing prior authorization can transform the way your organization operates for the better. Our partners benefit from:

Tenured experts: Hiring staff directly means you have to train and manage them yourself, which can take up a lot of your valuable time for the foreseeable future. Instead, let Global Healthcare Resource's trained professionals manage your prior authorizations.
Enhanced productivity: As we optimize your workflow to save you time in the long run, your staff can also look forward to more time to manage patient care and complete other essential tasks.
Increased return on investment (ROI): An offshore business partner like Global Healthcare Resource allows you to operate more cost-effectively and find new ways to expand your profit margins.

Why Partner With Global Healthcare Resource?

Global Healthcare Resource is proud to be your team of prior authorization specialists. As your partner, we dedicate ourselves completely to your purposes — we effortlessly integrate into your existing operations and optimize them through our:

Training and experience: Our leadership has over 20 years of on-the-job experience, allowing us to evolve with the industry. Plus, every staff member completes Global Academy, our exceptional training program, so they can start every project with the knowledge they need to succeed.
Quality, customized solutions: We develop custom service plans for every partner and adjust them until they are the most profitable for you. We keep our work in-house 100% of the time to maintain our rigorous standards.

Discover Our Full Suite of RCM Solutions

Be sure to take advantage of Global Healthcare Resource's full suite of revenue cycle management (RCM) solutions by investing in our:

Meet With Our Prior Authorization Specialists Today

Global Healthcare Resource's savvy prior authorization team is ready to become an essential integration of your staff. We have experience in every major EHR system, allowing us to transition seamlessly and start submitting requests right away.

Find the staff support you need to keep your prior authorization requests moving and your services cost-effective and efficient. Schedule a consultation with our team today.

What is patient eligibility verification?

Patient eligibility verification is the process of confirming a patient's insurance coverage and benefits before providing medical services. This crucial step ensures that healthcare providers receive reimbursement for services rendered. It involves checking the patient's insurance status, coverage limits, and any applicable co-pays or deductibles. By conducting eligibility verification, healthcare organizations can minimize claim denials and streamline the billing process.

Why is prior authorization necessary in patient eligibility verification?

Prior authorization is necessary in patient eligibility verification to ensure that specific medical services or procedures are covered by the patient's insurance plan. This process requires healthcare providers to obtain approval from the insurance company before delivering certain treatments, medications, or tests. Prior authorization helps control healthcare costs, prevents unnecessary procedures, and ensures that patients receive appropriate care based on their insurance benefits.

How does Global Healthcare Resource ensure HIPAA compliance?

Global Healthcare Resource ensures HIPAA compliance by implementing strict policies and procedures to protect patient information. This includes conducting regular training for staff on HIPAA regulations, utilizing secure electronic systems for data management, and ensuring that all communications involving patient data are encrypted. Additionally, Global Healthcare Resource performs regular audits and risk assessments to identify and mitigate potential vulnerabilities in their data handling processes.

How long does the eligibility verification process take?

The eligibility verification process typically takes anywhere from a few minutes to a couple of days, depending on the complexity of the patient's insurance plan and the efficiency of the verification system used. Automated systems can expedite the process, allowing healthcare providers to receive real-time updates on patient eligibility. However, manual verifications may take longer due to the need for additional documentation or communication with insurance companies.

What are the benefits of outsourcing eligibility verification?

Outsourcing eligibility verification offers several benefits, including:

Cost Savings: Reduces overhead costs associated with hiring and training in-house staff.
Increased Efficiency: Streamlines the verification process, allowing healthcare providers to focus on patient care.
Access to Expertise: Leverages specialized knowledge and technology from third-party vendors to ensure accurate and timely verifications.
Improved Cash Flow: Minimizes claim denials and accelerates reimbursement cycles, enhancing the financial health of healthcare organizations.
Scalability: Allows healthcare providers to easily adjust verification services based on patient volume and demand.

The integrity of your data is our #1 priority.

SOC 2 Type 2 Compliant.

SOC 2 Type 2 audits determine how well an organization safeguards customer data and how those controls operate over a 9-month (minimum) time frame. Reports are issued by third party auditors who review the following principles: Security, Confidentiality & Availability. Global Healthcare Resource is proudly SOC 2 Type 2 compliant.

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SECURITY

The security principle addresses whether an organization's system is protected (both physically and logically) against unauthorized access.

AVAILABILITY

The availability principle addresses whether the services an organization provides is operating with the type of availability that client's expect.

CONFIDENTIALITY

The confidentiality principle addresses the agreements made with clients in regard to how their information is used, who has access to it and how it's protected.

Global Healthcare Resource

Prior Authorization Outsourcing

Outsource prior authorization to save time and reduce denials.