Many companies, which are engaged in providing medical health services, make the common mistake of offering medical services, which have not been authorized by the medical insurance company. Sometimes the medically insured person might have the right authorization to avail of the required medical; services but they may not be possessing adequate proof of this and hence their medical claims can also be denied. It will take a long time to get this matter investigated and then provide the right kind of proof to the company which is providing medical services and this will also be a very expensive affair. The situation will be even more difficult to handle in the case of HMOs. When services are provided without checking out the authorization levels, the company is bound to lose a lot of money because it has been providing free services where a payment should be accepted.
But the process of referral request and authorization has been properly organized under the guidelines, which have been laid down by HIPAA. All the requests are being received and processed in an automated manner. The authorization for all the services will be recorded in the system. Since a record of all the authorizations has been maintained in the electronic media, all the documents, which are required, will be made available in a quick and easy manner whenever any doubt or question arises in the mind of any person regarding the medical insurance claims, which have been made, and the services, which have to be approved.
This system of recording all the authorizations, which have been attributed to every person, will help in reducing the time spent as well as the labor which is involved in the process of getting an authorization through the telephone or fax. Electronic authorization provides the staff of the medical center with the flexibility to a get a large number of procedures authorized without having to come into actual contact with a representative from the medical insurance company. This will also make it much more easier for the people who are working at the medical center to find a patient who does not actually belong to the network of patients in the beginning and they can always put in a request to make an exception. But this process of referral requests through the electronic media and authorizations through the electronic media is not something, which has been completely implemented in the offices of medical insurance companies. It is always better for them to get some kind of advice and consultation from an expert in the field of medical management services who will be able to perform the process of automating the entire system for them.
All the medical insurance claims will also have to be submitted in an electronic manner. When the claims have been submitted with the help of the electronic media, they will also be processed in a much quicker manner. All the medical insurance claims, which have been submitted electronically, will be sent directly to the office of the medical insurance company where they will get processed quickly. All the paper claims, which have been submitted, will have to be sorted and then made into batches before they are actually processed. The claims which are submitted through the electronic media will help in reducing all the expenses which are involved in the processing of claims and this will also make more time available in order to take good care of the patient. It takes 45 days in order to receive reimbursement on a paper medical claim while an electronic medical claim will be processed within a time period of 14 days.