Recently, I had a situation in an office of an allergy/immunologist – regarding a denial of the medication (that requires prior authorization), because of a failure to double check the spelling of medications; during a verbal prior authorization request. Please note that both medications did sound the same, however were two completely different medications. In thi situation, neither the prior authorization rep or the office manager asked for a spelling of the medication. Result: denial of the medication.
Remember medications requiring prior auth need to meet the medical policy standards (medical necessity), for that specific medication or you will receive a denial.
This is why I love to do an online authorization request instead. Once you fill out all the needed clinical questions and upload the needed medical notes, there is no confusion regarding which medications the patient is taking and how they are spelled or pronounced.
Investing in a scanner, for your office, is a great idea!
Now its your turn: have you used online prior authorization tool? Does your office have a scanner to scan documents?
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