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Automating Pre-Authorization Process


Many individual healthcare providers and provider groups today are orienting themselves toward HMO (Health Maintenance Organization) plans.  As the Health Insurance industry continues to push towards reducing Health Care Costs and improving the delivery of care, providers are finding themselves more involved in the HMO model as they seek to increase their patient base.

Given this direction of the Healthcare industry, the need for the PCP (Primary Care Provider) to interact with other practitioners such as Specialists and testing facilities is only going to increase. While patients are being referred to specialists, consulting providers, testing facilities and others, the process of acquiring prior authorizations for services is becoming a growing need. HIPAA transactions are a step toward automating these processes, further reducing costs and ensuring timely responses to authorization requests.

However, HIPAA authorization compliance is a two-way process.  Unless both sides participate in it, the transaction will not work.  This is why most of the communication of authorization requests still happens through faxes and phone calls.

Binary Spectrum is proud to announce its capability to support the HIPAA transactions to allow providers, groups, IPAs (Independent Physician Associations) and others to communicate authorization transactions seamlessly. Taking it a step further, by integrating our solutions with faxing capabilities, we make it possible for practices to automate the authorization process, irrespective of whether or not other groups or IPAs support the HIPAA transactions. To learn more about our HIPAA transaction solutions, Inquire Now.



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Hello Ashok,

Can u tell me what is the HMO model ??

Very good site! Thanks!

great post!!

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