Other Services

The Prior and Retro Authorizations department is responsible for obtaining approval from insurance companies for medical services before they are provided (prior authorization) or after they have already been provided (retro authorization). This department ensures that the necessary approvals are obtained to ensure that services are covered by insurance and that healthcare providers will be reimbursed for the care provided. Prior authorizations help prevent claim denials and ensure that patients receive the appropriate care, while retro authorizations help resolve issues that may have occurred when services were provided without prior approval.

OctaMD understands the importance of verifying patient eligibility and benefits before providing services. In fact, up to 75% of claim denials are due to patient ineligibility. Our comprehensive service is designed to help healthcare providers streamline the process and avoid unexpected financial surprises for patients.

The Prior Authorization (PA) process in the medical care process that determines the medical necessity and appropriateness of the proposed treatment or service. Our Department at OctaMD ensures a smooth PA process by following the steps below:

• Collecting Patient Information
• Reviewing Medical Necessity and Appropriateness
• Submitting PA Request
• Receiving Approval or Denial