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HOW CAN PRIOR AUTHORIZATION HELP?

 

PhiCure’s prior authorization software enables your medical office to more easily manage the validation of authorizations. We do this through a series of automated systems that handle validation and acquisition through an intuitive dashboard. Read the sections below to learn more about how our software works at each step of the process.

 

Validation:
First, the payer automatically verifies authorizations that are present on the patient’s record. This ensures that the procedure(s) and approved date ranges are accurate. Then, if an Authorization number fails validation, the system automatically looks for a valid Authorization on-file with the payer and returns that value to the user. This way the registration system can be updated.

If an alert is generated by PhiCure's knowledge rules, indicating that an Authorization is required and none is present on the patient record, the system automatically looks for a valid Authorization on-file with the payer and returns that value to the user so that the registration system can be updated. This process can be repeated at the Point-of-Service to validate the approved order has not been modified.

Automated Authorization Acquisition:
To begin, the system uses the data collected from the physician’s office portal, or staff at the hospital, to submit the request for authorization. It then queries the payer to check for either denial of authorization, request for additional information, or the authorization number. In short, the process uses Exchange technology for transactions where supported by the payer, or PhiCure's web harvesting technology to query the payer. Thus, it manages the communication with the physician’s office and hospital staff to complete the authorization process.
 
Authorization Dashboard:
The authorization dashboard communicates the result of “Automated Authorization Acquisition” to the hospital / facility staff through various alerts, for hospital initiated authorization requests. When the automated process has obtained an authorization, the alert informs the staff of the need to call the patient to schedule the appointment. When additional information is needed to complete the authorization, the alert then instructs the user to contact the appropriate party. If the facility has not responded to requested information or when a request for authorization has been denied, the system generates a corresponding alert for the user.
Solutions Features Title: How do we do it?
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Solutions Features Items:
  • , Step 1: Authorization Required?, When your staff schedules a procedure that may require a Prior Authorization, our system automatically confirms whether or not an Authorization is required. If an authorization is not required, our system sends a notification back to you. Otherwise, the Authorization request moves on to the submission stage.
  • , Step 2: Automated Submission, After submitting the Prior Authorization request, the system continues to monitor the payer behind the scenes until it receives notification requesting additional information or the successful submission of a completed authorization request.
  • , Step 3: Automated Response, When completed the practice will receive the authorization approval number “to-from” valid dates, other required data and an archived screen capture of the Authorization.
Solutions How Work Title: Benefits
Solutions How Work Items:
  • Centralized Dashboard to Manage Your Day
  • Reduced Labor Efforts from PhiCure's Automation
  • Eliminates Missed or Rescheduled Authorizations
  • Integrated E-Fax Solutions So All Users Have Faxing Capabilities
  • Auto-Post Results Back Into All Major PM / EMR Systems
General Hero Title: Prior Authorization
General Hero Text: Use Automation To Create Efficiencies In Your Office

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Category: Solutions
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  • Claims Processing: Reimagined, With PHIcure's EDIQ® Clearinghouse we offer connections to over 8,000 payers for professional, institutional, auto and workers’ compensation claims. By connecting directly to the payers wherever possible, claims are received faster to receive claim status results and reimbursement. Our analytics Dashboard turns your data into actionable tasks with graphical visuals and statistical data to give you greater control over your revenue cycle., images/Clearinghouse_2.png
  • Integration and Control, Our clearinghouse solution can integrate with any practice management system which provides the option to manage data in your billing application or directly in our secure user portal. Our dynamic rules engine is applied across each claim to deliver claim scrubbing that detects errors at no additional cost prior to submitting to the payers for review.  Tracking each claim as soon as it is received through payer adjudication allows you to see where the claim is in the process and determine when you can expect payment., images/solutions/laptop-mockup.jpg
  • Advanced Insight into Your Business, With customizable reporting, analyze critical portions of your revenue cycle, with the ability to search, sort and extract data for enhanced metric visibility. Easily identify trends and navigate data for long-term and short-term business planning. Advance reporting includes:
    • Claims Summary Report: displays all claims for any site while filtering on multiple criteria.
    • Errors and Rejections Report: shows all errors and rejections for all sites or any site.
    • Paper Claim Analysis Report: view paper claims by all sites or any site to identify payers that could switch over to electronic.
    • Payment Summary Report: check payment data for all sites or any site, submission period, plus drill into the data to understand payment metrics.
    • Payer Fees Report: see payer pass thru fees by transaction.
    • Trending Volume Report: allows comparison by day, week, or month volumes for claims, eligibility, and payments.
    , images/solutions/monitor-mockup.jpg
  • Support and Growth, Our U.S.-based client support services team is here to provide our clients with a full-service experience. From implementation to go-live, we provide intensive product training, specialized installation support and timely and accurate ticket issue resolution. Our formula for assisting your on-boarding experience sets the groundwork for your team to effectively use our platform to bolster your growth and focus on the financial health of your practice., images/solutions/customer-support.jpg
Solutions Features Title: Implement our EDIQ<sup>®</sup> Clearinghouse to leverage
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Solutions Features Items:
  • , Rejection Reduction, Lower paper rejections with our electronic connections for Claims (837) and ERAs (835).
  • , Dashboard, Visual dashboard showing one glance practice health.
  • , Connection, Connect to over 8,000 Payers including Claims, ERAs, Workers’ Compensation and Auto.
  • , Reporting, Specialized reporting tools to help providers increase their AR while decreasing their EDI costs and claims rejection rates.
  • , Easy set up, No additional hardware or software required.
  • , Notifications , Payer alerts and updates.
General Hero Title: Clearinghouse
General Hero Text: Elevate Your Claims Processing
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General Excerpt: Clearinghouse solutions and banking reconciliation for optimum financial health in the EDI landscape: reimagined. PHIcure’s solutions turn analytics into action items, boosting productivity. Our skillfully engineered automated product line is equipped with concise dashboards, highlighting the data you want, offers seamless integration with system interfaces, and connects you to the healthcare Payers you need to achieve your revenue goals.

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With the most robust ERA splitting application on the market, this tool allows you to separate and manage the routing of combined ERA files to the appropriate entity for proper posting. Original files are kept intact for reference and cataloging. With Q-Parse™, you can use one of our pre-defined library of splitting rules or build new ones to route every payment to its proper location.

This solution eliminates copying and cutting ERA files to ensure each group receives the proper payment data. This product can be used by anyone but is especially advantageous for health systems and organizations in the process of converting or installing new systems

 
Solutions Features Title: Experience Q-Parse™ Efficiency
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Solutions Features Items:
  • , Automated, Over 25 automated ways to split data.
  • , Flexible, User defined parsing criteria.
  • , Secure, HIPAA compliant over secure communication channels.
  • , Integrated, Parsed files are routed back to host system for auto-posting.
  • , Efficient, Save time and money and avoid cutting and pasting files.
  • , Accurate, Parsed and balanced back to the source.
General Hero Text: Parse through the noise of routing remittances.
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General Excerpt: The most comprehensive payment reconciliation tool in the market today, BankingQ automates the reconciliation of all healthcare payments virtually eliminating the manual processes and spreadsheets used today to balance the payment data. BankingQ delivers unmatched transparency of information, a high automated balance rate, and a reporting suite that provides unmatched value to both

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The BankingQ™ suite is changing the way medical groups manage and reconcile their revenue. By automating the reconciliation of all healthcare payments received in the revenue cycle PHIcure virtually eliminates the manual processes and spreadsheets used today to balance payment data.

Our system agnostic approach allows integration with any bank and any practice management system for full transparency. Our BankingQ™ product suite provides the most comprehensive financial data picture in the healthcare industry, allowing you to understand payments in your organization and validate every dollar into the system. 
Solutions Boxes:
  • Q-Post™, Converts paper EOBs and patient payments into electronic files for automated posting.
    • Access images and 835s anytime through our portal.
    • Eliminate posting paper payments by hand.
    • Connect directly to your bank lockbox.
    Read More, images/q-post.png
  • Q-Parse™, Automated routing of ERA files to the appropriate entity for posting.
    • ERA splitting.
    • Custom splitting rules ensure payment to proper location.
    • Consolidated billing support.
    Read More, images/q-parse.png
  • Q-Balance™, Reconciles and balances bank deposits to your practice management or billing system.
    • Validate every dollar to deposited funds.
    • Expert financial visibility.
    • Decrease the risk of fraud.
    Read More, images/q-balance.png
Solutions Features Title: With the power of BankingQ™
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Solutions Features Items:
  • , Integration , Connect practice management and billing systems to your bank.
  • , Eliminate Paper, Reduce use of paper and eliminate spreadsheets.
  • , Analytics , Review actionable data with payment analytics.
  • , Connectivity , 3-way matching between practice management systems, banks and clearinghouses with Q-Balance™.
  • , ERA , Splitting Rules based ERA splitting with Q-Parse™.
  • , Electronic Files, E-conversion of paper EOBs into electronic files available with Q-Post™.
General Hero Text: Advancing Healthcare Financials
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General Excerpt: Our BankingQ™ product suite offers three valuable applications – Balance, Parse and Post – to virtually eliminate manual processes, excess paper, and the use of spreadsheets to balance payment data. It is the next level of banking reconciliation. On their own our solutions will elevate your practice: together, they will advance you into the future.

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Q-Balance™ bridges the divide between banking systems and your practice management or billing solution. By automating manual processes, organizations can reconcile every payment in the system back to the bank deposits providing unmatched financial visibility to all levels of the organization and decreasing the risk of fraud. A complete reconciliation solution for all revenue within each financial institution.

Engineered to make financial reconciliation an automated process – our solution eliminates spreadsheets and the need to share information across multiple platforms. By automating the movement of data from your core systems (banks, practice management systems, and clearinghouses) all data is now housed in a single location and run across the rules database to balance down to the final dollar. With BankingQ™ the financial health of your practice will advance. 

 
Solutions Features Title: Financial Insight to Elevate your Practice
General Hero Image:
Solutions Features Items:
  • , Same Page. Same Goal., 3 way matching between practice management systems, banks and clearinghouses.
  • , One Place, Reduce reliance on spreadsheets and managing data in multiple locations.
  • , Robust Rules Engine, Built-in and custom rules that balance down to the last dollar.
  • , Automation, Streamline movement between banks, practice management systems and clearinghouses.
General Hero Text: Reimagine the Reconciliation Process.
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  1. Q-Post
  2. Eligibility