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txpec 1545 15

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Precertification request Amerigroup prior authorization: 18004543730 Fax: 18009643627 To prevent delay in processing your request, please fill out form in its entirety with all applicable information. Todays
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good morning Cynthia Anderson here with Cynthia Anderson dot-com I put out there a request to say what do you want to get trained on and I got this particular request from Sarah and so Sarah asks how do you create a process to perform prior authorizations great question so going back to the process of creating a procedure step by step procedure you can do this with any any function in your medical practice so lets just take that the prior authorization process so one step one is identifying the need right you know there needs to be a process so good check that off step two is identify who is gonna be primarily responsible for checking prior authorizations okay and put that person in charge of that task but then also identify who is going to be their backup when they call in sick when theyre out for vacation etc or if they ever leave the practice so you want to have a primary responsibility role and then you want to have a backup so thats step two so that once thats done then you are going to start to gather the information of that process so if were talking about the prior authorization process its looking at what process is in place now and who is doing that function so if it is a front office receptionist then were going to sit down with the receptionist and ask how do you currently do this and take notes gather that information who are you calling what are you asking what information are you getting where are you housing that how are you getting that prior authorization number over to your billing team so they can put it on the claim to move forward youre gathering that information start gathering that information next youre gonna start to compile your list or step-by-step list here I recommend doing in bullets okay so bullet points not too wordy simple ease do you understand and by steps so starting from the very beginning step one is this we Herman that a patient needs to get this procedure okay thats step one once this is determined step two is we determine that patients insurance company step three is that we contact that insurance company and depending on the insurance company there could be different paths that are followed so do we have to pick up the phone do we have a patient portal excuse me do we have a portal a payer portal do we have a method to get it through our practice management system to prior authorization can we get it through our practice management system that may might be a note that you might want to ask your practice management vendor so so we gathered that information and then we start that flow chart like I mentioned kind of earlier with the gathering information the flow chart is here is this step and if it goes one direction yes or no then it goes this direction and its the flow of it so if I got told yes or if I have to go online here are the steps that I need to go online what I need to print what I need to scan when I upload to the patients chart if I have to call on the phone then I also want to produce...