Sleep Study Insurance Verification and Authorization

21+

Years of Experience

98%

Claim Submission Accuracy

25%

Decrease in Outstanding AR

Simplify Sleep Study Insurance Verification and Authorization with Our Expert Support

Sleep studies or polysomnography help diagnose sleep disorders such as obstructive sleep apnea, narcolepsy, and restless leg syndrome. Insurance verification and authorization for sleep studies ensures that the procedure is covered by the patient’s insurance plan and the necessary prior approvals are obtained.

As an experienced insurance verification company, Outsource Strategies International (OSI) understands the complexities of sleep study insurance checks. Our expert team can help you navigate the challenges involved, such as:

Varying insurance policies
Plan specific requirements
Prior authorization requirements
Medical necessity documentation, and
Communication with payers, and more.

Outsourcing insurance verifications and authorizations to us can ensure smoother processes, reduced denials, improved cash flow, and better patient outcomes.

Overcome the Challenges of Sleep Study Insurance Verifications and Authorizations!

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Understand Insurance Coverage and Authorization for Sleep Studies during Appointment Scheduling

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Insurance Verifications

Our verification specialists are well-versed in the terms and conditions of each insurer’s policies. They will review patients’ personal and insurance details, including copayments, coinsurance, and deductibles and referral or prior authorization requirements. They will contact the payers to confirm sleep study coverage for CPAP devices, oral appliances and home sleep studies prior to services.
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Authorizations

As every situation is different, insurance companies usually require a great deal of information about the patient to make the decision whether to reimburse for a sleep study. Pre-authorization requires obtaining a concurrent diagnosis or referral from a physician. This includes a letter stating medical necessity as well as recent imaging. We help you submit pre-approval requests along with proof of medical necessity and other documentation.
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Why Choose OSI?

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Live calls

Our team verifies patient coverage and benefits by calling the insurance company. This enables us to obtain more detailed and up-to-date information than online or automated verification methods. With this real-time confirmation of patient eligibility and any required pre-authorization for upcoming services, you can provide timely care to the patient.

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Open communication

By maintaining open communication and a good working relationship with insurance providers, our team quickly and efficiently resolves any challenges or issues with the patient’s coverage. This collaborative approach with the insurance companies allows us to provide a clear, easy-to-understand explanation of the patient’s covered benefits and financial responsibilities for the recommended services.

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Expertise

Our insurance verification specialists have extensive experience. They are well-versed in the coverage policies for sleep studies of commercial insurance plans as well as Medicare and Medicaid. This deep understanding helps with accurate claim submissions for these services.

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We serve all 50 states

Our Patient Insurance Eligibility Verification Process

1

Patient data collection

2

Insurance verification

3

Pre-authorization

4

Communicating with the patient

5

Accurate documentation

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Patient data collection

Our team collects the patient’s personal and insurance information during the registration process. This includes the patient’s full name, address, date of birth, contact details, insurance provider name, ID/policy number, and requested sleep study service codes.

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Insurance verification

Patient coverage and benefits are verified using various tools and live calls. This step confirms the patient’s health plan, status of the coverage, copayments, policy limitations, deductibles, pre-authorization requirements.

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Pre-authorization

If the patient needs prior approval from the insurance company, we help you submit the request along with the necessary documentation. Our support can reduce administrative hassles and help obtain preapproval quickly. We also help you submit appeals if needed.

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Communicating with the patient

Our team works with your office to inform patients about the results of the insurance verification process including their financial responsibilities such as coinsurance, co-pays and deductibles. This helps them plan for their treatment.

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Accurate documentation

The patient’s electronic medical record or practice management system is updated with their verified insurance coverage information. The details are also seamlessly integrated into the patient’s overall treatment plan to help avoid any potential disruptions or coverage-related issues down the line.

Our comprehensive insurance verification process lays a solid foundation for smooth billing and claims submission throughout the entire course of the patient’s sleep apnea treatment.

Benefits of Outsourcing Insurance Verification to OSI

Dedicated team of insurance verification experts
Multi-level QA checks
Cost savings of 30-40%
Timely reporting based on your needs
HIPAA compliance

Pricing for Sleep Study Insurance Verifications and Authorizations

We offer different multiple pricing options:

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. We are also considering a blended model for AR.

Healthcare and Dental Revenue Cycle Management Process

Optimize your sleep study services with seamless insurance coverage verifications!

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FAQs

What does the insurance verification process for sleep studies involve?

The process involves confirming the patient’s eligibility, benefits, and any prior authorization requirements for the recommended sleep study. Our insurance verification specialists will verify coverage details such as deductibles, copays/coinsurance, and policy limitations. We obtain this information directly from the insurance provider to ensure accurate details.

How long does the insurance verification process take?

In most cases, our team can complete the insurance verification within 1-2 business days. This allows us to promptly provide you with the necessary details to proceed with scheduling the sleep study for the patient.

Do all sleep studies require prior authorization?

Coverage and authorization requirements can vary by insurance plan. Our team will research the specific policy details to determine if prior authorization is needed for the recommended sleep study. We’ll communicate this information to you upfront.

How do you handle denials or coverage challenges?

In the event of any issues or denials, our team will work directly with the insurance company to quickly resolve them. We maintain strong relationships with payers to streamline the appeals process when necessary.

What is the benefit of using your insurance verification service?

Outsourcing the insurance verification to our experienced team ensures the process is handled efficiently and accurately. This allows you and your staff to focus on patient care while we manage the insurance requirements. It also helps reduce claim denials and improve the overall patient experience.