We painstakingly review the relevant medical policies for multiple insurance carriers. Then we re-review them monthly to see if there are any changes in the medical necessity criteria. If there are changes, we let you know, and amend our templates to reflect the changes
Any procedure code that is on the precertification list for a specific insurance carrier can be requested on the QuickPrecert platform.
If a specific procedure or patient is more appropriately served under an inpatient level of care, we can help define what constitutes an appropriate inpatient status setting or when the patient is appropriately cared for under outpatient/observation level of care.
Standard medications as well as specialty medications are often subject to multiple criteria. We ensure that the medication requested is correct, has preferred status and appropriate dosing is outlined.
The majority of varicose vein procedures require precertification. Different carriers have different criteria and they are generally based on ultrasound results, vein size and reflux, and a duration of conservative therapy. Our customized, menu-driven form makes it easy to choose the right vein, the right procedure code and the right supporting clinical information.
Elective spinal surgery cases are on the national precertification list for essentially every insurance carrier. The potential for multiple levels, multiple codes, and multiple devices or ancillary products makes spinal surgery precertification a daunting task. Our intuitive, targeted template makes it easy to choose the levels of surgery, the procedure codes requested, and includes specific allografts or devices.
Bariatric surgery patients are complex and so are the precertification requirements. Insurance carriers vary widely with medical necessity criteria including the presurgical program requirements, impact of comorbid conditions for various levels of a patient’s BMI, and the required preoperative screening tests needed. By providing a templated roadmap, QuickPrecert guarantees a successful surgical approval.
Additional orthopedic surgery precertification options include viscosupplementation use, femoral-acetabular impingement surgery, and joint arthroplasty including appropriateness of inpatient level of care when clinical conditions merit an inpatient stay.
The most common breast surgery requiring precertification is reduction mammaplasty. The requirements are generally straightforward but each insurance carrier has a different approach to the number of grams required for removal to be consistent with their medical policy. QuickPrecert makes it easy!
The primary eye procedures that require precertification include blepharoplasty, blepharoptosis, and brow ptosis. A simple, menu-driven form ensures that the appropriate documentation is included and that the relevent ocular examination features are described.
Request for authorization of panniculectomy and / or abdominoplasty is complex as it requires critical clinical documentation as well as supporting photographic images. Our forms guide you on which images are needed and the best photographic techniques to optimize clinical relevance.
Requests for specific DME items or medical supplies can be extremely confusing. Knowing from the outset which items are allowable and considered medically necessary, makes providing the equipment much easier and faster. Custom requests are welcomed!
The broad clinical applications of botulinum toxin can make it challenging to incorporate the correct clinical to support medical necessity criteria. We help guide you with acceptable clinical diagnoses and specific indications for various botox formulations.
"If it needs precertification, we can help!"
In addition to our standard services, QuickPrecert provides several custom precertification services.
If you are a hospital, a payer, a health plan, an insurance provider, TPA, broker, diagnostic imaging provider, or ambulatory surgery center — any organization where you want to change, augment, streamline or create your own prior authorization process, the experts at QuickPrecert, LLC, will deliver a smooth and efficient prior authorization platform.
If an initial submission is returned with an unfavorable determination, the experts at QuickPrecert will conduct a peer to peer call with the insurance medical director to present the appropriate medical necessity criteria matched with the patient’s clinical information to overturn the initial denial.
If services are initially denied and if a peer discussion is not ruled in your favor, and in favor of the patient, an appropriately crafted and targeted denial letter, that is supplemented with the critical medical necessity criteria can result in the original denial being overturned. In your busy practice, you may not have the time or resources to produce such a letter. The experts at QuickPrecert can act in your stead.