"In-time delivery of quality healthcare services with maximum accuracy and security."

Authorization/ Pre Certification

Pre-authorization, also known as pre-admission certification is the process of obtaining authorization from the health care plan for routine IPD and OPD admissions. It is necessary before actual hospital admission or before care is provided and failure at this stage of billing process may result in penalty to the provider or the subscriber.

We perform accurate authorization, avoiding situations that can lead to non-payments of claims. Our process starts early as soon as the patient's demographics and other details are forwarded to us. This accelerates the process of precertification. At SPSOFT, our reviewers evaluate the clinical information obtained either by fax, phone or mail, against established online medical criteria. Cases that do not meet medical necessity or level of care criteria are referred to a physician advisor for final consideration. Our appeals process includes final evaluation by a peer-matched.