BLOG • Feb 19, 2025
Unlocking Revenue Potential: Why CARC Codes Are Essential for Denial Management
RCM CARC
🟢 Prior Authorization
Test Seamless Prior Authorization for a Smoother Healthcare Experience
Test We strive to create a seamless and hassle-free process for healthcare providers and patients, ensuring timely approvals and minimizing patient care delays
Schedule a Call90%
Turnaround Time
98%
Success Rate
~250,000
Requests Handled
Overview
Strategic Implementation in Healthcare Practices
Prior authorization is crucial in the healthcare industry. It is the foundation of a practice’s revenue cycle and is required for healthcare services
Specialized Payer Navigation Team
To speed up authorization procedures, our knowledgeable staff cultivates connections and is aware of insurers' subtleties
Technology-Driven Efficiency
Workflows are streamlined by automation in eligibility verification and prior authorization submissions, such as patient data that is automatically filled in
Medical Policy Leadership Experience
We can determine and verify the medical necessity necessary for a prior authorization to be deemed effective
Sturdy Workflow Management
Using specialist software, we closely monitor and follow up on requests for eligibility and prior permission to maintain regular contact with insurers
Data-Driven Decision Support
By directing medical professionals toward therapies and drugs with a higher chance of insurance acceptance, analytics tools can save time and money
Operations
Prior Authorization Services: Simplifying Approval, Empowering Care
Our expert prior authorization services streamline the approval process so you can focus on delivering exceptional care, not chasing paperwork
Eligibility & Timing Validation
To avoid delays or denials, we ensure the appointment falls within the approved authorization date range and meets any payer-specific visit requirements
Accurate Coding & Documentation
Our team submits precise CPT, HCPCS, and diagnosis codes that align with payer medical necessity criteria. All codes and clinical notes are thoroughly documented to support the request
Clinical & Service-Level Alignment
We verify if the requested services meet appropriate levels of care and are backed by a well-documented Plan of Care. When necessary, MRIs, psychological evaluations, and other clinical elements are included
Treatment History & Compliance
Where applicable, we confirm that conservative treatments or therapies have been attempted and documented, meeting payer prerequisites for advanced care approvals
Real-Time Review & Communication
Our team keeps close contact with payers and providers, initiating Peer-to-Peer reviews to support medical necessity and ensure timely decision-making
End-to-End Tracking & Follow-Up
From submission to approval, we monitor every step, addressing payer requests and minimizing turnaround time to keep your operations and patient care moving smoothly
Testimonials
Client Success Stories
FAQ
Frequently asked questions
Once we have safely received your patient and encounter data, we code, review, and send claims to payers. We also manage appeals and denials, track payments, and provide frequent updates. Our procedure is designed to be effective and open.
Our qualified coders and billing specialists evaluate every claim stringently. We employ quality control procedures, coding audits, and cross-referencing with payer requirements to guarantee accuracy and lower the possibility of denials.
Our denial management team examines every refused claim to identify the underlying reason. We quickly fix any problems and submit claims again, and where needed, we collaborate with payers on appeals to ensure you get the most money back.
Our pricing policy is adaptable and customized to meet every customer's demands. Usually, we charge a set fee based on volume or a portion of collections. Contact us for a quote tailored to your clinic's particular needs.
Indeed. Our specialty is smooth transfers from internal procedures or other billing businesses. To guarantee that all data is moved safely, our staff will collaborate closely with you and offer training as required.
Resources
Your Go-To Source for Resources, Industry Updates, and Expert Insights
Ready To Get Started
Share your details with us, and we'll set up a tailored demo just for you.
