Most insurance companies require their clients to fill out a Pre-Authorization form BEFORE they take the medical procedure. This is so that patients can be aware of whether their plan will cover the procedure.
Sometimes, clinics may assist patients in the process, but it is the patient’s responsibility to get the Prior Authorization filled out.
If the document is not filled out on time, most insurance companies will deny the claim. Natera is not obliged to get the form, as we don’t know who will be our patient in the future.
There are a couple of insurance plans that accept this document to be filled out even after taking the test. This is called a Retro Authorization.
Natera can cooperate by gathering the Prior Authorization confirmation number through our Prior Authorization Team.
- Billing agents MUST transfer the caller to the Prior Authorization department for ANY related PA issues/questions. (PA Denials, PA Submissions, Missing Prior Authorization.)
PA-RELATED ISSUES / QUESTIONS
Billing agents MUST transfer the call to the PA team for any PA-related issues/questions whether it’s in AMD or LIMS. ( PA never submitted, the claim was denied because of missing PA, PA not filed on time, and PA not submitted in a timely manner.)
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SPECTRUM PA questions/issues
Billing agents MUST transfer the call to the SPECTRUM team.PA never submitted, the claim was denied because of missing PA, PA not filed on time, and PA not submitted in a timely manner.)
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RENASIGHT TEST DOES NOT REQUIRE PA
- Before transferring the call, make sure you are speaking to the patient, or if it’s a third-party caller (Pt’s husband, Brother, Mother, etc), you MUST ensure the caller is authorized on the account so whenever the PA team takes the call. They know they can provide PA information to the caller.
- When attempting to transfer the call to PA team but they are unavailable (due to business hours or any other reason.) You MUST fill out a Prior Authorization – callback form and educate the caller that they will get a callback from the PA team within 72 BUSINESS HOURS.
- When filling out the form, you MUST add your first name and initial of your last name, the team you belong to, which is “Panam billing call center”, enter the patient’s case ID number, fill out the issue description as detailed as possible, add the patient’s best callback phone number, patient’s email address, and make sure to ask the patient the best time he/she can be reached and their time zone, and add that information to the callback request form.
Last update by: Claudia F (July 30, 2024)