Shouldering the Burden: Increasing Demands for Prior Authorization and Medical Records

Shouldering the Burden: Increasing Demands for Prior Authorization and Medical Records

Claims submitted without prior authorization (PA) and medical records can result in claim rejections, more back-end AR work and diminished collections.

The use of PA is expanding to cover more—yet less costly—tests. Obtaining PA may be the responsibility of the physician or patient, however, the reality is laboratories have an increased burden assuring PA is obtained prior to claim submission.

Depending on the type of testing provided, a payer may require medical records or a PA every time for a bill code a specific patient situation. The laboratory has yet another burden of fulfilling payer requirements before claim submission.

Here are five ways laboratories leverage TELCOR RCM to ease the burden and reap benefits:

1. Leverage rules, not people, to catch probable payer requirements
The TELCOR RCM rules engine catches situations where PA or medical records are required before a claim is ever generated assuring compliant claim submission and reducing time to payment.

2. Put down the phone and let TELCOR RCM automatically contact clients
If medical records, PA or other missing information is required, these requests are automatically presented to your client via portal, fax or email. Communication is streamlined and everyone’s efficiency is improved.

3. Translate Payer responses into action
If an organization receives rejections on the backend requesting medical records or an authorization number, TELCOR RCM can diagnose the remittance advice and generate an automated request back to the client based on the payer’s response.

4. Provide a hassle-free process for providers to provide documentation
With a dedicated client portal, customers can easily upload medical records or complete PA information ensuring their data exchange with the organization is encrypted and secure, followed with an automatic an update to TELCOR RCM.

5. Transform a burden into increased cash collections and staff efficiency
Reap the benefits of the TELCOR RCM automation. Allow your staff to focus energy on collections instead of manual efforts and decrease time to payment by notifying your payers up-front with claim submission that records are forthcoming.

If you’re not currently taking advantage of these benefits, contact Sales or Service to discover how TELCOR can help you shoulder the burden of the increasing demands for prior authorization and medical records.


Kurt Matthes, vice president, RCM reengineering and service, has more than 25 years of experience in laboratory systems. Since joining TELCOR in 2007, he has performed various responsibilities including implementation, service and sales support working with TELCOR customers to help ensure success.

2018-10-23T11:32:43+00:00