8 Steps-Getting a Preauth Approved

Lindsay Della Vella

6 years ago

So while this isn’t directly coding related and is a little different from the usual stuff on this blog, I thought this might be an important topic to cover for some of you out there. Let me just start by saying, I used to be one of those people who got scared just by the idea of talking to someone from an insurance company. I’m not sure why but it just sounded really intimidating. Me? Phone? Insurance company? No thanks. So when my boss asked me once to temporarily step in and help get the preauths done because the person who normally did it was going out on leave–well you can imagine my trepidation. But, I still wanted to help out, so I did. But first I kind of had to get a system down so I wasn’t nervous making these phone calls. Here is what I did and maybe it will help you.

Have all the facility/dr info ready and written down on a piece of paper (if you’re old school like me) or in a word document on the computer. You’ll need the dr name, facility address, NPI number, phone number and fax number. You will also have to give your name, but I’m assuming you know what that is already 🙂

Have all the patient info ready. You will need their name, address, birth date, insurance ID number, date of appointment and the CPT code that you’re doing the authorization for. All of this would be found in whatever EHR you are using.

Next look at the back of the insurance card and get the number to call the insurance company. (Note–there are some insurances where you can submit an authorization electronically through either Navinet or Availity. For purposes of this post, we’re just talking about submitting an authorization via phone).

Call the number and go through the prompts. This is where you’ll enter all the info you have written down on the piece of paper. Now, if it’s determined that you do have to start an authorization, you’ll be connected to a representative.

Now, the representative will ask you a few questions. (It’s pretty much the same info that you entered in for the prompts). Then they will ask you why you are calling and if you want to start the authorization process. Say yes (that’s why you’re calling right? :))

Now the representative will start the process and will tell you what to do next. They will either approve your authorization and give you an auth number or tell you that you have to fax in the clinical information for the patient (they will still give you a pending auth number). If you have to fax more information, there may or may not be other forms required that you have to fill out from the insurance company. They will fax this info to you. Once you get it, fill it out and then fax back the forms with the clinicals.

Now, this depends on the EHR that you’re using, but I like to put notes somewhere in the file documenting what I did. Did I start the auth? When? Who did I speak to? What is the pending auth number? Did I fax in the clinicals yet? This is especially important for a couple of reasons. 1–it shows you’re doing your job. 2. It’s leaving a record of everything in case you have to call back. 3. You’re doing this for a lot of patients. There has to be some kind of system to keep track of where you are, and leaving notes helps.

It can take up to 2 weeks for the insurance company to process your info once you send it to them. If you see it’s approaching the 2 week mark and you haven’t heard back that it’s approved, it’s best to give them a call. Ask them if there’s anything else you need to do. Hopefully this won’t happen often, but every once in a while you might have to refax everything, if the fax didn’t go through or whatnot.

Well, that is basically the whole process. Good luck guys 🙂