CLAIMWISE BILLING
Pre-Authorization and Utilization Review
We get behavioral health services approved and covered for patients - quickly and easily.
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ClaimWise Billing Solutions offers complementary pre-authorization and Utilization Review (UR) services as a part of our revenue cycle management for drug and alcohol addiction treatment centers, therapists, and other behavioral health providers.
Take a closer look below.
What IS utilization review?
Utilization review is the necessary process of obtaining an insurance carrier’s authorization to bill specific services for a patient, also referred to as prior authorization. The purpose of utilization review is to prove to insurance companies the medical necessity of the services being rendered by the mental health or substance abuse providers.
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Once we prove the medical necessity of a level of care or service for a client, the insurance carrier generates an authorization number that we utilize during the billing process for the specific dates of service authorized. Most major insurance carriers require authorization.
Behavioral health utilization review
To obtain pre-authorization, we need accurate and up-to-date clinical information to provide to the insurance carrier. UR specialists at ClaimWise will thoroughly review a client's clinical information gathered at the time of their admission or initial consultation and relay that information to the member’s insurance company. Then, we fight for the coverage of your patients.
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Most major carriers approve authorization of a service using one of many medical necessity criteria standards. Some of these standards are proprietary to the carrier themselves, while others are used more uniformly across the industry. Luckily, ClaimWise has years of experience working to obtain pre-authorization approval for various insurance companies and services.
With these standards changing constantly, it’s our UR specialists' job to navigate this web of policies and guidelines. And we're sure you'll be satisfied with the result.
Why Claimwise?
Utilization review services are the bridge between client care and billing services. To get the best reimbursement rates, you need to have knowledge of both.
ClaimWise has over 10 years of combined experience and extensive knowledge of therapy services, medical necessity guidelines, clinical requirements set by insurance companies, specific insurance plan requirements, and the CPT and revenue codes required.