Navigating The Prior Authorizations Process: How To Maximize Revenue Opportunities

Obtaining prior authorizations for care can be confusing, time-consuming, and frustrating, especially if you work with numerous insurance companies. Each payer can have its own policies governing prior authorizations, concurrent reviews, retrospective reviews, and appeals. Failure to obtain timely prior authorization and continued stay review can result in delayed or denied claims. Specialty provider organizations have long been subject to more intensive gatekeeping than others. ;

​Historically, health plans have limited mental health or addiction treatment mechanisms to manage costs. For example, a commercial benefit might be limited to 20 outpatient sessions per year, or the annual total expense . . .