Insurance Verification & Prior Authorization

Your Practice’s Safeguard Against Claim Rejections

FC Billing is your practice’s safeguard to claim denials, costly write-offs, and high insurance outstanding.

Verification & Prior Authorization

At FC Billing, we ensure detailed insurance coverage check for each patient, assessing benefits and verifying referral and prior authorization requirements.

Our Prior Authorization team secures insurance approval for medical services before patient’s visit, preventing claim denials and billing obstacles.

Eligibility

Determine patient’s insurance coverage status and requirements.

Referral

Confirm need for referral and validity of referral on file.

Co-Insurance

Our eligibility team assess patient’s responsibility for shared costs for services.

Co-Pay

Verify co-pay responsibility for visits.

Deductible

Identify individual, family, and remaining deductible for the appointment.

Out-Of-Pocket

Calculate total patient responsibility for the year.

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Verification & Prior Authorization

Benefits of working with FC Billing

Which Services Require Prior-Authorization

Each insurance plan is unique in its requirement for service coverage. Unless the practice is absolutely certain that authorization is not required, such as traditional Medicare, billers should confirm with insurance for all high-value services. Common services which might require Prior-Authorization are:

  • Medication/Drug
  • In-Office surgery/procedure
  • Outpatient surgery center or hospital Services
  • Physical or Mental therapy
  • Health plans which allow limited number of medical visits per year or have frequency limits for tests and procedures
  • HMO, POS, Medicaid, and other approval based plans
  • Out of network services
define prior authorization in healthcare

Opening Hour

M – F: 9.00 AM to 5.00 PM
Sat & Sun: Only by appointment

Email us

info@myfcbilling.com

Call Us

(540) 609-7404

Address

19415 Deerfield Ave STE 105, Lansdowne, VA 20176, United States

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Insurance verification ensures accurate billing and minimizes claim rejections, leading to improved revenue and operational efficiency.

We typically require patients’ insurance details, including policy numbers, group numbers, and primary insured information, along with personal details such as name, date of birth, and contact information.

We utilize various channels, including clearinghouses, insurance portals, and direct communication with insurers, to verify coverage details such as co-pays, deductibles, and prior authorization requirements.

Without verified insurance coverage, there’s a risk of claim denials and delayed reimbursements. Patients may also be billed incorrectly, leading to dissatisfaction and potential financial issues.

In case of denial, we work closely with the insurer to understand the reason for denial and appeal if necessary. We also explore alternative options to ensure patients receive the necessary care.

Our team proactively addresses any issues or discrepancies during the verification process, seeking clarification from insurers when needed. We keep clients informed and provide solutions to resolve issues promptly.