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- Reimbursement Support Programs
— We tailor our reimbursement support programs to meet your
needs. We offer an "a la carte" selection of services
provided by dedicated healthcare professionals including but not
limited to patient registration/Triage, case management, benefits
verification, prior authorization and pre-determinations. We also
assist providers with claims management and billing and coding
issues. Our reimbursement support programs are designed to ensure
that all avenues for reimbursement are explored and exhausted
by our team of professional case managers.
- Patient
Registration/Triage: We understand that
reimbursement can often be a major consideration in a physician's
decision to treat and a patient's decision to accept therapy.
Physicians and patients may not know or understand how the specific
therapy gets covered under their insurance, where they can receive
the product and what process they will need to go through. Our
experience has shown us that setting up a simple triage solution
can provide both physicians and patients a single source of
information to get the process started. At Premier Source we
can register the patient through a simple one-page document
filled out by the physician and patient and then assist both
the physician and patient in getting the prescription into the
correct hands.
- Case Management:
Depending on the level of complexity of the patient's diagnosis,
history and insurance status we offer a comprehensive case management
program. In working with our clients we develop an extensive
case management approach which not only registers the patient
but also walks the physician and patient through the process
until the patient begins therapy. Our involvement in the case
may even continue on to cover regular patient follow-up or recertification
as required by the insurance carrier.
- Benefits
Verification: Our experienced case managers
can work with the patients insurance to determine their eligibility,
plan and benefit type including in and out of network rates.
This helps to determine under which benefit the product will
be paid and also the allowed provider. We work to determine
the most beneficial option for the patient and explain the coverage
in simple, easy to understand terms.
- Prior Authorizations/Pre-Determinations:
As the insurance industry becomes extremely cost conscious,
more and more therapies and products are requiring a pre-determination
or prior authorization. By performing these evaluations the
insurance carrier is essentially reviewing for medical necessity
and upon judgment gives approval to the patient to start the
treatment. At Premier Source we have unlimited knowledge in
working with insurance carriers to educate them on the disease
state, the product and the overall medical necessity of such
a therapy. We work tirelessly to ensure required medical documents
are in the hands of the reviewer along with answering any questions
that may arise. Once a final outcome has been determined we
provide the information back to the physician and patient so
that treatment can begin.
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Here
are the different solutions:
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