Insurance verification and prior authorization

Step-by-Step Breakdown

Detailed explanation of each automated stage in the workflow.

1. 1

   Trigger

   Patient Evaluation Scheduled

   A new physical therapy patient is scheduled in the practice management system. This triggers the insurance verification and prior authorization workflow.

   WebPTClinicient
2. 2

   Action

   Extract Patient Insurance Data

   System automatically pulls patient insurance information, policy numbers, and demographic data from the EMR. Insurance card images and contact details are compiled for verification.

   WebPTPrompt EMR
3. 3

   Action

   Verify Insurance Coverage

   Automated eligibility check is performed against insurance provider databases to confirm active coverage and PT benefits. Real-time verification results are obtained including copay and deductible information.

   TherabillRaintree Systems
4. 4

   Decision

   Check Authorization Requirements

   System determines if prior authorization is required based on insurance type, diagnosis codes, and treatment plans. Decision branches workflow to either proceed with scheduling or initiate authorization request.

   TherabillClinicient
5. 5

   Action

   Submit Prior Authorization Request

   Automated prior authorization forms are generated with diagnosis codes, treatment plans, and physician orders. Electronic submission is made to insurance provider with all required documentation.

   BreezyNotesRaintree Systems
6. 6

   Action

   Track Authorization Status

   System monitors authorization request status and sends automated follow-ups if needed. Updates patient record with approval numbers, visit limits, and coverage details.

   TherabillWebPT
7. 7

   Output

   Generate Verification Report

   Complete insurance verification and authorization summary is created for the clinical team. Report includes coverage details, approved visit counts, and any coverage limitations or requirements.

   WebPTPrompt EMR

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