Leveraging TELCOR RCM to Support Prior Authorization

Let’s face it. Prior authorization requirements from payers are becoming a larger part of a laboratory’s revenue cycle, impacting workflows, provider relations, and a laboratory’s bottom line if not managed effectively. How do you manage prior authorizations effectively? By taking control of your prior authorization process.

Discover How to Streamline Your Prior Authorization Process

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3 Ways to Streamline the Prior Authorization Process

1. Initiate the billing process by routing charges to TELCOR RCM upon test order.

If prior authorizations are needed for a significant portion of your business, consider initiating the billing process by routing charges to TELCOR RCM upon test order, allowing you to get a jump start on the prior authorization process within the tight timeframe payers require. By leveraging the TELCOR RCM prior authorization workqueue, labs can distribute and manage prior authorization request packages and monitor the effectiveness of the entire process, especially for payers allowing labs to initiate the prior authorization process.

2. Configure the authorization request package for the provider.

For payers only allowing the referring provider to initiate the prior authorization process, labs can participate in that process as well. The authorization request package can be configured to contain everything the provider needs to get the authorization, including step-by-step instructions and supporting forms or documentation, simplifying the providers’ administrative burden. It can also be advantageous for the lab if your providers submit the authorization request via fax rather than through separate online credentials, so you can retain the ability to track and follow up on the status of the faxed request.

3. Automate the communication process using TELCOR RCM tools.

The client information request process can also be used to notify the provider that an authorization is needed and the iLabBill® Client portal can be used for providers to submit their obtained prior authorization number, which will automatically be updated on the patients account in TELCOR RCM.

Having direct control and visibility to your prior authorization process is key, such as making decisions to release a test on hold for prior authorization and work it on the back end as an appeal or continue to follow up with the payer if there has been no response to the prior authorization request. Being able to control these pivotal decisions are benefits of using TELCOR RCM to control and manage the prior authorization process rather than outsourcing it where you may lose oversight, visibility, and the ability to make strategic decisions.

Navigating Prior Authorization with Proven Strategies from TELCOR

Kwami Edwards, Chief Customer Officer at TELCOR, discusses the complexities of prior authorization for laboratory billing and four strategies TELCOR has seen to be successful for customers.

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