Secure clinical authorizations for complex medical cases, reducing denials.

Clinical authorization is a requirement from health insurance companies to ensure procedures and treatments are medically necessary, and healthcare organizations are facing significant administrative and clinical challenges to obtain prior authorization from payers for inpatient and outpatient services. Services that require clinical authorizations include:

• Elective surgeries (non-emergency)
• Oncology (chemotherapy) services
• Infusions and other therapies
• Experimental and investigational services
• High-cost drugs and devices

We help you secure clinical authorizations for complex medical cases, including prior authorizations (prospective) and concurrent authorizations, to ensure proper reimbursement and timely delivery of care aligned to payer contracts. Sharing clinical information to support the medical necessity required to obtain authorizations is an imperative part of the process to mitigate denials.

AGS Health provides seasoned, experienced resources to support clinical authorizations. Clinical prior authorization services provided include:

• Eliminating backlogs of pending authorizations
• Monitoring communication between providers and payers
• Concurrent authorization
• Providing necessary medical codes
• Faxing services
• Peer to peer review

Benefits

Proper Reimbursement Streamline processes to close communication gaps between providers and payers to maximize revenue cycle efficiency for accurate reimbursement.

Mitigate Denials Reduce errors that can lead to denials and resubmissions, minimizing the financial strain caused by denied claims.

Timely Delivery of Care Ensure services are aligned with payer contracts to ensure patients receive necessary treatments and optimized care plans without unnecessary delays.