Prior Authorization Outsourcing
The CMI Group is a preferred provider of prior authorization outsourcing for health systems, hospitals, clinics, and private practice. Not only will The CMI Group’s outsourcing solution save your business office considerable time and money, but our team will relieve the administrative burden of complex workflows and a large administrative staff.
A Critical Step
Obtaining a prior authorization is critical a step in pre-service that confirms that a patient’s insurance will cover particular medical services. Missteps in the prior authorization process can spell trouble for claims reimbursement and can even damage your relationships with patients and third-party payers.
A Rising Challenge
In an environment where continual change is the norm, managing workflows across third-party payers is becoming challenging for a business office to handle on its own. With new treatments being developed each year and each third-party payer requiring their own unique intricacies, obtaining all your prior authorizations has not gotten faster or easier. Payer-specific requirements demand dedicated focus that most billing offices cannot meet unless they have personnel whose sole job is to manage the prior authorization process. Because of the increasing complexity, the process has become burdensome and disruptive for individual practices resulting in:
- Delayed treatment for patients
- Increased overhead
- Staff turnover
- Administrative complexity
Outsourcing Benefits
If you struggle to keep up with insurance eligibility and prior authorization workflows, it may be time to consider an outsourced solution. Many providers who have turned to outsourcing have benefited from:
- Simplified Administration
- Dependable Quality & Accuracy
- More Time for Core Activities
- Consistent Staffing Levels
- Cost Savings
- Scalability
- Flexibility
CMI’s Outsourced Solution
CMI obtains prior authorization for treatments, procedures, and admissions via careful coordination between patients, providers, and third-party payers as your outsourcing partner. We have everything perfectly aligned to the goal of supporting your practice as a seamless back-office extension, including:
1. Centralized Operations
Our team is specialized in prior authorization workflows and has developed consistent, centralized processes. In addition, our processes are enhanced by electronic systems and automation that minimize errors.
2. Compassionate Communication
When patients contact their healthcare provider seeking guidance and reassurance, some are in a distressed emotional state. CMI’s prior authorization staff treats patients with compassion during every interaction.
3. Flexible Staffing Options
CMI has domestic facilities as well as accent neutral near-shore and off-shore options.
4. Comprehensive Training
Our prior authorization staff undergoes a comprehensive training curriculum during onboarding. In training, they learn about your medical specialties and services as well as:
- Customer service skills
- System(s) and usage
- Payer-specific requirements
- Compliance requirements HIPAA
- Call quality expectations
After agents have finished a training section, our trainers leverage our learning management platform’s knowledge retention features to reinforce key learning points. Our agents must successfully pass all quizzes and exams and demonstrate proficiency on the phone before graduating from the program, ensuring your agents are well prepared before taking live calls.
5. Following Data Security Protocols – HIPAA and PCI-DSS
Electronic Health Records (EHR) and Individual Health Records (IHR) are stored and transmitted in compliance with HIPAA regulations to prevent security breaches and protect Personal Health Information (PHI). Providing critical assurances, CMI’s external audits verify our compliance with all required data security laws, regulations, and standards, including:
- HIPAA
- PCI-DSS
- SSAE18 SOC 1 and SOC 2 Type II
To ensure your continued compliance, our staff receives thorough HIPAA training, ensuring they follow security protocols when interacting with your patients and third-party payers. In addition, we work closely with you, following all regulatory guidelines regarding data ensuring it is protected when utilized.
Relationships Matter
Our motto, “Relationships Matter,” is embodied in CMI’s dedication to building strong and collaborative partnerships with our clients. The CMI Group partners with hospitals, surgery centers, and medical offices across the country. We can support the full range of medical specialties and have distinguished expertise in:
- Oncology
- Cardiology
- Allergy / ENT
- Pediatrics
- Orthopedics
- Physiatry/ Physical medicine
- Infectious Disease
- Ophthalmology
- General Surgery
- Gastro
TAKE ACTION
If you need a hand with insurance eligibility and prior authorization workflows, then click below to see how CMI can help you simplify administration and save money:
