The majority of denials can be prevented or avoided by checking healthcare payer authorization requirements — including prior authorization and medical necessity — prior to or at the time of service. This leads to patients being able to make more informed financial decisions about their care, as well as improved patient access processes.
Help validate prior authorization requirements
Confirm medical necessity through a streamlined process
Protect revenue and improve efficiencies
Confirm medical prior authorization requirements in real time before service to avoid denials and reduce administrative costs. With our solution, you can utilize a comprehensive, up-to-date rules library comprised of more than 16,000 medical codes to help:
Accurately determine medical necessity prior to service to better inform patients, improve medical documentation and reduce financial risk.
"Combining medical necessity compliance checks with a contracts-based patient payment estimator and propensity to pay information empowers our staff with the tools necessary to educate patients on their payment options. It also reduces our financial risk for claim denials post service. We expect this to have a significant impact on our point-of-service collections and net revenue as we’ll know earlier in the process how much the patient owes, and what procedures will be covered by their insurance company."
TransUnion Healthcare client
A Better Patient Experience Benefits Everyone
Uncompensated Care Reimbursements: Navigating the Uncertainties of Worksheet S-10
How Utilizing SDOH Data Can Make a Big Difference in Predicting Risk and Managing Care
FY 2020 Hospital Inpatient PPS Final Rule Update: Worksheet S-10 and Uncompensated Care