Verify and Pre-Authorize without the pain

The Next Health Choice system offers a simple and straightforward online application for handling pre-treatment administrative tasks required by insurance companies. Through a consolidated and systematic workflow, the Next Health Choice system removes the eligibility/benefit and pre-authorization burden from your team, which in turn reduces costs, increases productivity, and makes everyone happier. Completely eliminate phone calls, endless hold times, and conversations with robots.

B&E Verification

Next Health Choice provides all the same information as benefit management software and Clearing Houses, with additional value-add services to verify coverage for any procedure, with any payer.

The ROI is based on the hours per procedure per employee your team spends on verifying and validating these points of information. Based on industry averages, the cost savings can range from a few hundred dollars a month to tens of thousands (via multiple FTEs per year).

Preventing Claim Denials

Checking if the patient has active insurance, and if pre-authorization is needed, is only part of the process to prevent claim denials. The Next Health Choice system reviews medical policies for coverage and helps your staff identify what must be included to meet medical necessity, including the correct ICD-10 code.

Benefits & Eligibility Service Next Health Choice Others
Check eligibility
Provided current deductible/OOP
Verify copay/COINS
Check if a general service is covered
Verify labor funds or self funded plans
Verify if a specific CPT code is covered
Provide/review medical policy for medical necessity
Check if ICD-10 code is applicable to medical policy
Call/Follow up when coverage is unclear
Check if Pre-Authorization is required

Pre-Authorization

Full Process Pre-Authorization

Next Health Choice handles pre-authorization from start to finish. Our system confirms if a Pre-Authorization is required, and if so, completes the authorization and generates documentation for your records. Our system continuously checks the status of all Pre-Authorizations and notifies you of delays, changes, or if a peer-to-peer review is required. If necessary, we provide direct contact information and reference number(s) to make peer-to-peer reviews as seamless as possible.

We have dedicated humans-in-the-loop as a safety valve to our automation to handle the extra-ordinary, so no request falls through the crack.

Preventing Claim Denials When Pre-Authorization is Not Required

A service is not necessarily approved automatically when pre-authorization is not required. A medical necessity review may be required with the claim. If a service is determined to not be “Medically Necessary”, the provider or patient may end up with a large, unexpected bill.

Next Health Choice mitigates this risk by completing a medical necessity review before the service, using payer specific criteria and guidance. If the payer allows, Next Health Choice will complete the voluntary pre-determination process to confirm coverage.

Pre-Authorization Service Next Health Choice Others
MRI/CT Scan
PT/OT/ST
Cardiac & Vascular Ultrasound
Electroencephalogram
Durable Medical Equipment
Orthotics/Prosthetics
Bone Morphogenic Protein
Orthopedic Surgery
Spine Pain Management
Botulinum Toxin
Acute & Ambulatory Care
Injections (i.e. Viscosupplement, Facet, Epidural, et al)
Studies (i.e. Nerve Conduction, Sleep, etc)
Labor Funds, Carve Outs, Self-Pays
Work Comp

Features

  • Simple format - Intuitive
  • Standardized layout - Same for every payer and procedure
  • Improve efficiency - Spend less time on this
  • Reduce Denials - Get Paid for your work!

Common questions

Which features are available with your program?

  • Works with all payers
  • Standardized workflow
  • Dashboard
  • Paper Trail

Can I reduce time spent on paperwork?

Absolutely! Our workflow standardizes your process, so you get the same experience for any payer . You only have a simple, streamlined process to adminster.

Is there a guarantee we will not be denied?

Next Health Choice cannot provide any guarantee of payment. Payers often make it clear, especially in their documentation, that a Pre-Authorization does not guarantee payment. We work diligently to reduce the chance of denial based on policy information and provide the most accurately available information. Next Health Choice provides a document trail that provides assurance in case of claim denials.

What is the normal turnaround time?

Our system processes many requests in different fashions. All initial eligibility verifications are real-time. Benefit information may require processing and dependent upon payer information may be instantly available. Pre-Authorizations are the most lengthy procedure, with requests ranging from minutes to weeks. We streamline the entire process so you don't have to do anything other than move on to your next task.


More patient time, less office work

Get in touch with Next Health Choice today to learn more.

HIPAA

Next Health Choice is HIPAA and HITECH compliant. Our policies are available online for you to review.