Providers

7-Steps to Avoid Prior Authorization Denials

The SamaCare Team

The SamaCare Team

As recent AMA data shows, prior authorization denial rates remain significant across all health plan products. 


However, the process for navigating why claims are denied is complex and time-consuming, often varying by health plan product type and plan details. For practices this leads to operational expense, morale challenges, and negative outcomes for patients

While prior authorization denials are not always preventable, here are 4 common mistakes SamaCare sees in prior authorization submissions and how to avoid them: 

1. Policy not active

How to avoid: Verify patient eligibility through the payer, your EMR, or an eligibility vendor prior to submitting a prior authorization. 

2. No authorization needed

How to avoid: Pharmaceutical manufacturers offer services like Benefits Investigations that help answer patient access questions. For drugs where SamaCare works with the drug company, providers can submit Benefits Investigations in one click on the SamaCare platform, identify which patients require prior authorizations, and translate the BI into a partially completed PA request. For other drugs, providers can often check whether an authorization is needed directly on the insurance company’s website.  

3. Sent to the wrong fax number

How to avoid: Always verify benefits and fax number prior to submitting a prior authorization — the same fax number may not be correct for patients with the same payer/plan. SamaCare makes this process easy by centralizing the most up-to-date payer forms in one portal. 

4. Wrong form used

How to avoid: Forms may vary by state, medication, or type of policy. Always verify these factors before submitting a prior authorization. SamaCare makes this process easy by centralizing the most up-to-date payer forms in one portal. 


The 7-Step Checklist

So what is the quickest and most accurate way to submit a prior authorization? Here is our 7 step checklist for efficient and effective prior authorization submissions:

How else can you avoid prior authorization delays and denials? Schedule a quick demo and we'll show you how practices are leveraging SamaCare (for free!) to streamline prior authorizations and improve patient care.

Providers

7-Steps to Avoid Prior Authorization Denials

The SamaCare Team

The SamaCare Team

As recent AMA data shows, prior authorization denial rates remain significant across all health plan products. 


However, the process for navigating why claims are denied is complex and time-consuming, often varying by health plan product type and plan details. For practices this leads to operational expense, morale challenges, and negative outcomes for patients

While prior authorization denials are not always preventable, here are 4 common mistakes SamaCare sees in prior authorization submissions and how to avoid them: 

1. Policy not active

How to avoid: Verify patient eligibility through the payer, your EMR, or an eligibility vendor prior to submitting a prior authorization. 

2. No authorization needed

How to avoid: Pharmaceutical manufacturers offer services like Benefits Investigations that help answer patient access questions. For drugs where SamaCare works with the drug company, providers can submit Benefits Investigations in one click on the SamaCare platform, identify which patients require prior authorizations, and translate the BI into a partially completed PA request. For other drugs, providers can often check whether an authorization is needed directly on the insurance company’s website.  

3. Sent to the wrong fax number

How to avoid: Always verify benefits and fax number prior to submitting a prior authorization — the same fax number may not be correct for patients with the same payer/plan. SamaCare makes this process easy by centralizing the most up-to-date payer forms in one portal. 

4. Wrong form used

How to avoid: Forms may vary by state, medication, or type of policy. Always verify these factors before submitting a prior authorization. SamaCare makes this process easy by centralizing the most up-to-date payer forms in one portal. 


The 7-Step Checklist

So what is the quickest and most accurate way to submit a prior authorization? Here is our 7 step checklist for efficient and effective prior authorization submissions:

How else can you avoid prior authorization delays and denials? Schedule a quick demo and we'll show you how practices are leveraging SamaCare (for free!) to streamline prior authorizations and improve patient care.