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.
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|
|Provided current deductible/OOP|
|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|
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|
|Cardiac & Vascular Ultrasound|
|Durable Medical Equipment|
|Bone Morphogenic Protein|
|Spine Pain Management|
|Acute & Ambulatory Care|
|Injections (i.e. Viscosupplement, Facet, Epidural, et al)|
|Studies (i.e. Nerve Conduction, Sleep, etc)|
|Labor Funds, Carve Outs, Self-Pays|
- 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!
Which features are available with your program?
- Works with all payers
- Standardized workflow
- 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.