How To Navigate The Prior Authorizations Maze To Maximize Revenue Opportunities

Failure to obtain timely prior authorization and continued stay review can result in delayed or denied claims—not something any provider organization needs as revenues are already affected due to COVID. And behavioral health provider organizations have long been subject to more intensive gatekeeping than others. Historically, plans limited mental health or addictions treatment mechanisms to manage costs. For example, a commercial benefit might be limited to 20 outpatient sessions per year, or the annual total expense could be limited. These models are all designed to save the insurance company money. Even after passage of the Mental Health Parity and . . .