Eligibility Verification and Prior Authorizations
ELIGIBILITY VERIFICATION
It is not unusual for an employer to change employee health plan offerings each year, or for employees to switch plans annually, as each group looks for ways to reduce expenses. These frequent, ongoing changes increase the importance of accurate, upfront eligibility and benefits verification for all healthcare providers. Having access to the most up-to-date eligibility and benefits data increases clean claims rates, eliminates costly rework and accelerates reimbursement.
PRIOR AUTHORIZATIONS
Prior authorization is a process used by health insurance companies in most states to determine if they will cover a prescribed procedure, service, or medication. The process is intended to act as a safety and cost savings measure, although it has received criticism from physicians for being tedious, time consuming and expensive. In certain states like CA, almost all patient visits in certain specialties require a prior authorization, including follow up visits. Allowing GoSoft to obtain all prior authorizations for the office significantly saves time and fosters a patient-centric focus by the front desk. In addition, this is a very significant step in preventing delayed payments and speeding up reimbursements.

