Substance Abuse Insurance Verification and Authorization

  • Dedicated Manager
  • Expertise in Handling Insurance Processing
  • Verification During Appointment Scheduling
  • Flexible Pricing with No Start-up Fees or Long-term Contracts
  • Customized Solutions
Call: (800) 670-2809
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21+

Years of Experience

98%

Claim Submission Accuracy
25%
Decrease in Outstanding AR
Ensure Seamless Substance Abuse Insurance Verifications and Authorizations

Seamless Insurance Verification and Authorization for Substance Abuse Treatments

Substance abuse treatment covers a range of services and insurance coverage has distinct criteria and requirements. While mental health services are covered by insurance plans, medical detox and substance abuse services often have separate coverage criteria, limitations, and authorization requirements. As patient eligibility may change, verifying coverage regularly is crucial.
Outsource Strategies International (OSI) provides efficient, real-time substance abuse insurance verifications. We check the specifics of what treatments are covered, the extent of the coverage, and any associated costs. We integrate with your systems to streamline workflows and administrative tasks.
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Say Goodbye to Denials – Let OSI Handle Your Verifications and Authorizations

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Comprehensive Eligibility Verification and Billing for Substance Abuse Treatments

Insurance Verifications

We ensure the patient’s demographic and insurance data is valid and current and confirms their eligibility for substance abuse coverage under plan. Key aspects verified include inpatient (residential) and outpatient treatment programs for substance abuse, detox services, short-term and long-term rehab, and Medication-Assisted Treatment (MAT).
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Medical Coding

Accurate medical billing depends on proper code assignment. Our coders will review the treatment plan and recommended services, and assign the appropriate CPT, HCPCS, and ICD-10 codes relevant to this specialty. By ensuring accurate claims the first time, we help you maximize revenue, reduce denials and avoid risks of appeals or rework.
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Authorizations

Our insurance verification process will identify whether prior authorization is required for the patient’s addiction treatment. We help you submit preapproval requests in a timely manner to prevent treatment delays and ensure that patients get the care they need when they need it. If prior auth is denied, our team will work with you to appeal the denial quickly.
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AR Follow-up

Our insurance verification process sets the stage for an efficient accounts receivable (AR) follow-up. We track the status of each claim, monitoring for any denials or delays in reimbursement. This allows us to quickly identify and address any issues. By resolving problems early, we can optimize your overall revenue cycle management (RCM).
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Why You Should Choose OSI

Real-time verification via calls

In addition to checking payer portals, our team directly contacts insurance companies to verify patient eligibility in real time. This hands-on approach helps us correctly confirm coverage and benefits for substance abuse treatment.

Open communication with insurance providers

Our team maintains ongoing, transparent communication and collaboration with insurance providers. This expedites the verification process and allows us to efficiently resolve any issues that may arise around coverage details, leading to timely approvals.

Extensive experience

OSI has extensive experience in the medical billing field. We follow some of the best billing practices developed over our industry experience of more than 20 years. We focus on improving your practice’s RCM while you help your patients recover from substance abuse disorders.

We are up-to-date on substance abuse billing and coding regulations

Our insurance verification specialists are knowledgeable in the policies and requirements of both commercial and government payers.

Our services are available for all types of facilities and providers

We provide services customized to meet the specific requirements of each facility, whether big or small.

We have the right expertise

At OSI, we make the best use of the latest advanced technology and expertise. Our experts are thorough in insurance verification and authorization, and all other aspects of medical billing. They keep abreast of all industry trends so that our clients are notified of any changes in the health insurance field.

We ensure compliance

We make sure that all relevant documentation that providers need to be in true compliance with payers is available.

Customized reporting

This is something every provider looks forward to. We provide customized reporting so that our clients are kept up-to-date with the current happenings on their account.

These unique strengths position us to deliver exceptional accuracy in billing and coding. As a result, we can help maximize your revenue potential by ensuring claims are submitted correctly the first time.

We serve all 50 states

Our Medical Insurance Eligibility Verification Process

1

Collecting Patient Information
9
Communicating with the Patient
4
2
Performing Verification
9
Initiating Prior Authorization

5

3
Documentation
9
Updating the Billing System
6

1

Collecting Patient Information
"
2
Performing Verification
"
3
Documentation
"
4
Communicating with the Patient
"
5
Initiating Prior Authorization
"
6
Updating the Billing System
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Collecting Patient Information

When a patient schedules an appointment or arrives for a visit, we collect all necessary details. We set up a dedicated file for each patient, creating an easily accessible centralized repository.
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Performing Verification

We verify the patient’s coverage and benefits, including checking if the insurance policy is active at the time of service. This is done by calling the insurance company, using an online portal, or through the electronic health record (EHR) system.
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Documentation

All verified information is entered into the patient’s file, so that it is easily accessible to the billing staff.
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Communicating with the Patient

We inform the patient about the verification results. This ensures the patient understands his/her coverage details and financial responsibilities, such as co-insurance, co-pays, and deductibles.
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Initiating Prior Authorization

If the patient requires prior authorization for a particular service, we submit the necessary clinical information to the insurance company for approval.
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Updating the Billing System

Your practice’s billing system is updated with the insurance verification and eligibility details.

Benefits of Partnering with Us

  • Reduced denial rates
  • Maximize revenue
  • Get performance and claim quality data
  • Reduce administrative time
  • Increase efficiency
  • More time to focus on core responsibilities
  • Higher patient satisfaction
  • Reduced errors with multi-level QA checks
  • Cost savings of 30-40%
Benefits of Partnering with Us

How Our Substance Abuse Insurance Verification Services Are Priced

Reduce administrative hassles and welcome efficiency with our skilled team supporting you. Choose from our flexible pricing plans based on your needs.

Full-Time Equivalent

In this model, services are billed based on the equivalent cost of a full-time employee (FTE) for a specified duration, usually monthly or annually.
Per Verification Billing
Like an FTE model, a person is dedicated to your practice. Perfect for a practice that is busy. They work as an extension to your business.
FTE/Per Verification Billing
This option is ideal for a practice that is unsure about their work requirements. This can have per request pricing for eligibility and other functions.
AR Is Only FTE

In this model, you will be charged a fixed monthly or annual fee based on the number of full-time equivalent staff required to manage your practice’s AR follow-up activities.

Healthcare and Dental Revenue Cycle Management Process

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FAQs

What types of substance abuse treatments does insurance typically cover?

Most insurance plans cover a range of treatments, including detoxification, inpatient rehabilitation, outpatient therapy, medication-assisted treatment (MAT), and counseling services. However, the specifics can vary widely between policies.

Are there limits on the number of treatment sessions or days covered by insurance?

Yes, many insurance plans have limits on the number of covered treatment sessions or days, especially for inpatient care. It’s crucial to verify these details to understand any potential caps on coverage.

What happens if a service isn’t covered by insurance?

If a treatment or service isn’t covered, the patient may have to pay for it out-of-pocket. In such cases, your facility can work with the patient to discuss alternative payment options or financial assistance programs.

How long does it take to get prior authorization?

The time required to obtain prior authorization may vary depending on the state, the method of transmission, and the urgency of the service or medication. Typically, electronic prior authorization (ePA) requests for medications receive responses within 2 business days, often within 24 hours. Manual submissions for healthcare services can take up to 15 business days for a response. In urgent cases, decisions are generally made within 72 hours of submission.