Pre-Authorizations are a prerequisite in assuring compensation from insurance payors. This step is often designed as a rate-limiting or cost-containing, legal conditions written into medical insurance policies when an expense is anticipated but the actual cost is uncertain. This is a provision of care and treatment that must be addressed in a systematic and timely manner. A treatment facility asking for higher levels of care, for example, residential substance abuse and who expects to be paid for services rendered, must obtain a pre-authorization from the insurance company. This authorization outlines specific criteria to determine medical necessity for the care of a covered individual. Initial level of care is determined in this step. This process is done before treatment is provided. It is customary to provide a thorough clinical evaluation to establish detailed diagnostic criteria for the requested treatment procedures.
Illuminate Billing Advocates can help treatment providers, establish a system that improves authorization approvals for medically necessary treatment. We are not just here to facilitate the Pre-authorization, but to help you put best practice protocols in place, simplify the process and keeping collaborative communication lines open with insurance companies. When pre-authorization is obtained it begins the treatment process and starts the wheels in motion for the Utilization Reviews (UR) which will follow. Every pre-authorization generates an NDA, Illuminate provides a Number of Days Authorized (NDA) report, indicating the authorization outcome with any limitations, requirements, instructions and other detailed information. We pride ourselves on effective communication with our partners.
Number of Days Authorized
Number of Days Authorized (NDA) is generated following pre-authorizations and utilization reviews (UR). This document is time-stamped, specific in detail and often contains helpful suggestions or instructions to prepare for the next UR. Illuminate makes this information readily available to our treatment partners. It is our goal to communicate prompt, accurate information.