Priority of Prior Authorization Services in Specialty Pharmacy

Prior authorization for Specialty pharmacy billingIn recent times, specialty pharmacy business is slowly gaining momentum in the US healthcare spectrum. It is also considered as a unique growing industry. The industry, like any other, needs specialized attention to get rid of the glitches that are faced on a regular basis. Being a niche segment in the market, specialty pharmacy billing, coding and prior authorization are the foremost areas to look into. To diminish intermittent issues, leading outsourcing agencies are making a swift entry to work in coordination with specialty pharmacies to tackle problems and keep them running smoothly.

For a specialty pharmacy, prior authorization should be given preference over other processes. There are some imperative fundamentals that outsourcing personnel perform, while rendering skillful management, for specialty pharmacies, to curb the prior authorization glitches often faced by them. It increases reimbursements and cash flow while curtailing rejections and denials.

Outsourcing personnel set the right approach for rendering customized services for specialty pharmacies. It includes regular analysis, follow-up, and review to keep the prior authorizations on track. As specialty pharmacies lend their services to oncology, multiple sclerosis, rheumatoid arthritis, Crohn disease, HIV/AIDS, hepatitis C, and growth hormone disorders, prior authorization remains a critical part of their operations.

How outsourcing reduces the usual hassles of prior authorization:

♦ Preparing proper documentation, guidelines, and checklists are major areas they focus on.

♦ The leading outsourcing agencies define proper tracking mechanism through various reports— aging status, daily, and exception.

♦ It also generates exception reports and regular audit of every process task. For example, transaction audit minimizes errors and reduces denials due to missing patient information.

♦ Moving to EDI based submission, whenever possible, reduce cost of manual work and makes the payment cycle faster.

Prior authorization is widely considered to be a major problem area by most pharmacies. However, with an able partner to assist in the process of getting specialty drugs prior authorized quickly and accurately, much of the woes can be removed. This, in turn, will pave the way to better client satisfaction and a smoother, more consistent cash flow.


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