Wiki PRIOR AUTHS

Crik

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In our organization we have several clinics - Orthopedics, Podiatry, General Surgery, OBGYN etc. Currently we have I believe three individuals in the clinics that strictly do the Prior Auths for patients that are going to have surgeries. that is their main jobs to research all medical records, get physical therapy lined out if that is the need before surgery, ultrasounds before surgery, Peer to Peer reviews if that is what is necessary etc. I am not clinical (not a MA, LPN or a RN) I have been in the field since 2007 but have only been certified as a CPC since 2015 and have been a Coder/Biller for 15 docs. What is your process for this? Who does your Prior Auths? Are they in the Clinics and that is their main job or are they in Rev Cycle Department where the Coding and Billing happens? Thanks for your help.
 
I work for a small Rheumatology practice (5 docs and 2 NPs) across 2 offices. We have a nurse at each office that does our Prior Auths due to the clinical aspect of the requests.
 
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