The prior authorization processes for various orthotics and prosthetics devices vary from one payer to another. Taking up a lot of time during the prior authorization process, orthotics and prosthetics prior authorization process have specific criteria which must include:

• A prescription from the ordering physician dated before the delivery date.
• Consideration of limitations based on the time period within which the item can be covered if supplied earlier.
• Proper modifiers must be billed, e.g., KX, LT / RT, NU, etc.
• Coverage of devices also subject to qualifying diagnosis, e.g., orthotic shoes are not covered unless diagnosis states diabetic

The criteria for successful and seamless orthotics and prosthetics prior authorization process do not end here. For a successful authorization, one must require experienced authorization experts with complete authorization awareness. This, at times, becomes challenging for many in-house staff, which eventually results in outsourcing their authorization process.

PriorAuth Online: The Perfect Outsourcing Option for Successful Orthotics and Prosthetics Prior Authorization Process:

Filling all the authorization gaps faster and efficiently, PriorAuth Online powered by Sunknowledge Services Inc is the perfect outsourcing partner to ensure a seamless authorization process. With an efficient revenue generation, PriorAuth Online takes the complete responsibility of all authorization initiation, approval, and follow-up. With 100% prior authorization submission on the same day, PriorAuth Online experts also increase the authorization rate by 1.5-2x.

Why PriorAuth Online Different from Other Authorization Destination:

Detailed Eligibility Verification & Authorization Requirement Checking

  • Re-verification of eligibility with assigned codes
  • Updating detailed code specific benefits
  • Verifying authorization requirements (Code Specific)
  • Creation of Service Estimates (Payer Specific and Reasonable and Customary)
  • Sending complete written order/diabetic verification form and other paperwork to doctor’s office for signature

Doctor’s Office Follow-up

  • Contacting doctor’s office for pending detailed written order/diabetic verification form and other paperwork as well as patient calling

Authorization/Pre-Determination/Referral Initiation

  • Creation of Insurance Authorization Form
  • Requesting Authorization/Pre-Determination/Referral (Via Phone/Fax/Email)

Authorization/Pre-Determination/Referral Follow-up

  • Follow-up with the payer on Authorization/ Pre-Determination/Referral status
  • Completion of authorization form based on the outcome of the request

Working as a part of an internal team rather than an allusive third Party, PriorAuth Online today has more than 100s of satisfied clients with excellent industry credentials. Reducing your operational cost, we are the perfect one-stop destination ensuring seamless orthotics and prosthetics prior authorization process.


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