RCM Benefits, Referrals & Prior Authorizations for Beginners

Master the authorization workflow: Get a clear, step-by-step guide on how to request prior authorizations, submit required documents, and follow up effectively with insurance companies.

Verify patient eligibility and benefits: Learn how to check insurance coverage, interpret plan types (HMO, PPO, Medicare, Medicaid), and identify when referrals or authorizations are required.

Set up productivity metrics: Understand how to define KPIs (Key Performance Indicators) and SLAs (Service Level Agreements) to measure performance and improve workflow efficiency.

Get familiar with tools and systems: Explore how Practice Management Systems (PMS), Electronic Health Records (EHR), and payer portals are used to streamline front-end processes.

Handle denials and follow-ups: Learn how to respond to referral or authorization denials, gather supporting documents, and submit appeals when needed.