Why Pre-authorization Is Critical To Medical Billing Success

What do you do after you get back your verification of benefits?  First, you need to decide if you are going to move forward with medical insurance as a courtesy to the patient.

Next, you need to check and see if any of your codes need pre-authorization. If yes, then doing a preauthorization will be your next step.  In medical, unlike dental, if a code requires pre-authorization you must obtain it, or they will deny your case.  Very rarely do they grant retro authorization. At Imagn Billing, we always recommend applying for preauthorization as soon as possible. In order to file for the pre-authorization, you should ask the insurance representative during the verification of benefits call how that needs to be done:

  • Fax
  • Mail
  • Phone Call
  • Insurance Specific Form

With Imagn Billing, you can request a pre-authorization in minutes and our team will provide all the legwork of contacting the insurance company and getting the information that you need. 

  • Pre-Auth for Up To 12 Codes
  • Submission
  • Attachments
  • Aging and Follow Up Until Processed
  • Level 1 Appeal When Applicable

Be prepared to supply medical insurance with both the medical procedures and diagnosis codes. Chart notes will also be supplied either during the application process or shortly thereafter. 

Documentation & Organization 

Make sure you always have your list of documents in order before you call.  This list varies by procedure and can range from something as simple as chart notes to more complex things like letters of recommendation and outside provider referrals. A response for a preauthorization can sometimes come at the end of the phone call, or it could take up to 30 days. Typically, a response takes 10-15 business days, so make sure to plan the treatment accordingly.

There are several responses that may come for a preauth. They could say “yes, we agree to this covered service”, or “no, it’s not medically necessary” or “not a covered benefit/plan exclusion”.

It is important to stay organized when receiving pre-authorizations. Imagn Billing gives you the ability to filter your cases so when you are waiting for a response you can make sure no cases fall through the cracks. Below you can see how the pre-authorizations are filtered to show approved, submitted, and info sent to Imagn Billing.

Appealing Pre-Authorization Denials 

Appealing a denial based on the lack of medical necessity is possible but can be difficult. However, it’s even more difficult to appeal a plan exclusion. If you receive a medical necessity denial it either has to do with your coding or your supporting chart notes. You can appeal if a pre-auth is denied, but note that it is much harder to appeal a plan exclusion denial. If the services are approved then make note of the expiration date. All services covered under the authorization must be completed by the expiration date or you will have to apply for an extension or do a new authorization.

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Imagn Medical Billing Service

Due to the complex nature of medical insurance billing, most dental offices are not equipped with the knowledge to properly credential national payers, submit successful claims, or handle aging and appeals. Imagn Medical Billing Service performs the proper credentialing and billing for you, which results in fewer denials and time well saved as you rely on expert help.

One-Time Credential Fee

$795/per dentist

The key to more successful payments

Our experts complete the process so you can start billing medical insurance. Each dentist billing medical insurance needs to be credentialed.

Pay Per Case

Verification of Benefit

$35 per vob

We get your patient’s insurance information so you can set proper expectations with the patient regarding the specific coverage available and any out of pocket fees. This is the most critical step in all of medical billing.

Per Authorization

$40 per auth

All procedures require pre-authorization in order for your practice to get paid. Gaining appropriate authorization can be challenging, let our experts get the job done for you.

Claim Submission

8% of successful claim

You don’t have time to sit on hold. Let us sit on hold and handle the claim submission work for you  We also handle the aging and appeals so you can focus on your practice.

Choose Your Software

Imagn Software is your one stop solution with both medical billing and dental sleep medicine capabilities with world-class support

What most dentist don’t know is that medical billing can increase your case acceptance rate and ensure your patients get the care they need.

Imagn Software

$195 /month

No contract and your satisfaction guaranteed.

Our goal is to give you the best experience. But if you are not satisfied then we will give you a full refund for your software access fee within 30 days of purchase.

Add Imagn Sleep Software

$100 /month

Our software provides everything you need

to give your patient’s the sleep care they deserve.

Patients can no longer afford to have dentists ignore the responsibility of providing care for sleep disorders. Two out of every three Americans report poor sleep; the ability to breathe well is the most important factor in determining a person’s sleep quality. 

Imagn Software Set-up Fee

$399 one-time fee

No contract and your satisfaction guaranteed.

Our goal is to give you the best experience. But if you are not satisfied then we will give you a full refund for your software access fee within 30 days of purchase.

Choose Your Monthly Devdent Support Program

In order for you to succeed, we offer a unique range of customer support solutions including coaching, online resources, implementation programming, and so much more. We keep an eye on the ever changing industry trends so you can focus on your practice

Medical Billing Support

$200 /month

The program to get and keep your staff trained.

Dental Sleep Medicine Support

$200 /month

The program to implement Dental Sleep Medicine into your practice.


$345 /month

Get both of the Medical Billing and Dental Sleep Medicine Support programs at a discount.

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