Medical Office Workflow Step 3: Obtaining Procedure Authorization

During your insurance verification process, you became aware that one or more of the services you will be either providing or ordering for your patient require an authorization.

For a guide on Proper Insurance Verification follow this link:

If you have no current method in place for obtaining authorizations, use the following suggestions to create your office process.

1 Gather all pertinent patient information: name, date of birth, insurance policy number and contact information for the authorizing entity.

 The authorizing entity can be the insurance company, but more and more frequently payers are contracting out to third party organizations to perform this function.

2 Obtain the following data:  accurate diagnosis including the ICD9 or 10 code, copies of related medical records, the history and physical report from your physician, and the procedure(s) ordered with the appropriate CPT code(s).

Because you will need accurate medical data on your patient and in some cases actual office notes to provide to the authorizing entity, your hands may be tied in regards to the speed in which the authorization can be obtained.  For this reason, it is always helpful when possible to schedule the services enough into the future as to allow for processing time.

Now that you have the basics you are ready to begin the authorization process.  Follow the guidelines indicated by the authorizing entity to complete your authorization request.  This can vary from phoned in requests, to online or faxed submissions.  Make sure to complete any forms as accurately and thoroughly as possible. 

It is helpful to compile a file on authorization processes for each authorizing entity you encounter.  This allows you to have the information readily available again and again.

4 Now you wait.  With online submissions, you may have your authorization within seconds or minutes.  Other authorizing entities may take      24-48 business hours as their standard turn around.  You may even on occasion experience a week or more time between the request and the response. 

If you fail to get a response in the time specified by the entity, do not wait idly by.  Call or email as follow up.  You may discover the request was incomplete so you are able to provide the additional needed information.   Unfortunately, sometimes it is just floundering around on someone’s desk and you have to make sure it is brought to their attention.

5 Once you have received your authorization make sure to pass it on to the appropriate party:  the billing staff in your office for an in office procedure, the hospital or outpatient facility, or the diagnostic center. 

You are .  Hopefully we have taken some of the mystery out of obtaining authorizations for your patients.