What is Prior Authorization?

Prior authorization (prior auth, or PA) is a management process used by insurance companies to determine if a prescribed product or service will be covered. This means if the product or service will be paid for in full or in part. This process can be used for certain medications, procedures, or services before they are given to the patient.

ROI of a Prior Authorization Specialist

Prior authorizations (PAs) can be a costly step that gets in the way of patient access. Data from EviCore Healthcare shows that on average, each prior authorization costs $11 for providers and that it has a detrimental impact on patient adherence where approximately half of patients struggling to adhere, especially with specialty products. So, why […]

Calling All Patient Advocates!

Have you been working with patients to re-evaluate their commercial health plan or Medicare plan?  As a patient advocate, now is the time.  Open enrollment for 2021 is underway and ends in a few short weeks! For Medicare patients and all patient advocates helping during this time, the enrollment deadline is December 7th! For commercial […]

5 Mistakes Field Reimbursement Teams Cannot Afford to Make

1) Not Listening to HCP needs Health care providers have direct patient interaction and drive the access to medications. Therefore, field reimbursement teams should be in tune with their needs and their frustrations as the first gatekeeper to the medication is the provider. Education and assistance are keys to having the support system for the […]

Importance of the HIPAA Security Rule

Patient confidentiality is one of the most important aspects between a healthcare provider and a patient. Confidentiality strengthens the trust of a patient-physician relationship and ensures the quality of care and patient autonomy. Prior to the implementation of HIPAA, the healthcare industry lacked a set standard or requirements regarding the protection of health information. Simultaneously, […]

A Look into Peer to Peer

What is Peer to Peer? Peer to Peer (or P2P) is essentially the patient’s doctor justifying a patient’s medical order, prescription, or inpatient status to the insurance company’s medical director. These interactions occur when the payer denies a claim according to their own internal policies and requirements.  This is usually required within 72, 48, or even […]