Discover How VES Optimizes the Authorization Process

This workflow ensures that medical providers have a smooth and transparent process for verifying insurance and determining a patient's eligibility, reducing administrative burden, improving patient care, and ensuring the correct patient collections. 

1.  Patient Information Collection - Email: Providers are to provide the patient's insurance details via email.  Required Fields: Name, Date of Birth, Insurance Provider, Policy Number, Contact Information, and reason for visit.
2.  Insurance Verification Process - Automated Verification: Integrate with insurance databases to automatically verify patient coverage and benefits.  Manual Verification: If automation fails, a team member manually contacts the insurance provider to verify coverage.
3. Eligibility Check - Eligibility Criteria: Verify specific plan details, such as deductibles, copayments, and covered services.  Real-Time Status Updates: Display real-time eligibility status to both the patient and provider.
4. Notification to Provider - Electronic Notification: Send an email or SMS to the provider confirming the patient’s insurance status and any out-of-pocket costs.  Next Steps: Provide details on next steps, such as patient scheduling or documentation needed.
5. Documentation  - Secure Portal Access: Allow providers to upload necessary documents through a secure portal.  Document Verification: Review and verify uploaded documents for accuracy and completeness.
6. Final Eligibility Confirmation - Approval Notification: Notify both the provider and patient once all verifications are complete and eligibility is confirmed.  Appointment Scheduling Link: Offer a direct link to schedule an appointment or proceed with the service.
7. Ongoing Monitoring and Updates - Regular Updates: Automatically check for any changes in patient coverage or eligibility status.  Proactive Alerts: Send alerts to both patients and providers if any issues arise with coverage.

Customer Support

 A helpline or chat support for providers is provided to address any questions or concerns promptly.

VES will customize any workflow to fit each provider's unique needs.

 This workflow ensures that medical authorization submissions are handled efficiently and accurately, reducing delays in patient care and maximizing the chances of approval.

1. Patient Information Collection - Form Completion: Collect patient details including demographics, insurance information, and medical history via an online or paper form.  Required Fields: Name, Date of Birth, Insurance Provider, Policy Number, Diagnosis, Treatment Plan, and Provider Information.
2. Initial Assessment - Review of Necessity: Assess the medical necessity of the requested service based on provided patient information and clinical guidelines.  Documentation Gathering: Collect all required supporting documentation (e.g., medical records, physician notes, lab results).
3. Preauthorization Request Submission - Form Preparation: Complete the insurance-specific preauthorization request form, including all necessary patient and provider information.  Attachment of Documents: Attach all supporting documentation to the preauthorization request form.  Submission Method: Submit the request via the preferred method (e.g., electronic submission, fax, mail).
4. Follow-Up - Confirmation of Receipt: Verify that the insurance company has received the preauthorization request.  Communication with Insurer: Maintain regular communication with the insurance company to check the status of the request.  Additional Information: Provide any additional information requested by the insurance company to support the authorization.
5. Decision Notification - Approval Notification: If approved, notify the patient and provider of the authorization decision, including any coverage limitations or conditions.  Denial Handling: If denied, review the reason for denial and determine if an appeal is warranted. Communicate the denial and appeal process to the patient and provider.
6. Appeals Process (if necessary) -  Preparation of Appeal: Gather additional supporting documentation and prepare a comprehensive appeal letter addressing the reasons for denial.  Submission of Appeal: Submit the appeal to the insurance company and confirm receipt.  Follow-Up and Decision: Monitor the status of the appeal and communicate the final decision to the patient and provider.
7. Documentation and Record-Keeping - Record Maintenance: Keep detailed records of all preauthorization requests, communications, and decisions for future reference and compliance purposes.  Audit Preparation: Ensure all documentation is readily available for potential audits by insurers or regulatory agencies.

VES will adjust as needed to fit your specific practice requirements!