Providers: it is important that the front desk or scheduling department of your office contacts all of the insurance companies you have agreed to accept from patients, to find out what is required prior to a visit in order to be paid.
Several procedures and services require preauthorization, or the approval of the treatment plan before services can be rendered.
In or out of network, every insurance company for each specialty has different guidelines for what is and is not necessary to receive preauthorization.
If the provider is out of network, most of the time preauthorization is required whereas for the same procedure, an in-network provider may not always be (but sometimes it is) required to receive preauthorization.
Whether the patient is seen in the office or the hospital, getting preauthorization is the physician’s responsibility. After receiving preauthorization, the provider only has a certain amount of time to complete the procedure because it does expire. If you are an in-network provider and do not get preauthorization for the service you have provided (and the insurance requires it) you will not get paid and you cannot bill the patient.
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