What types of drugs require PA?
Drugs subject to PA include brand name medicines with generic alternatives, expensive drugs, drugs for non-life-threatening conditions, and those not
Why do health insurance companies require pharmacy prior authorization?
Health insurance companies use PA to ensure that prescribed drugs are medically necessary and cost-effective. It helps minimize costs by
What is pharmacy prior authorization?
Prior authorization (PA) is a requirement for healthcare providers to obtain approval from a health plan before delivering specific services,
Credit Balances
Managing credit balances, where providers receive more money than billed, is critical. Identifying overpayments and promptly refunding them is essential
Denial Management
Denials or reimbursement issues should be addressed promptly. If a claim is denied, billers work to resolve the issue. This
Patient Payments
Once remittance advice is posted, patient statements are sent for outstanding balances. Timely patient statement delivery facilitates quicker payments. These
