Best Practice

When you file a claim, what happens to it? The answer may be more complicated than you think.

Starting on January 1, the AllWays Health Partners provider portal became your single-stop for claims and eligibility checks. On the portal, you can check these in less than a minute. Previously, it could take up to 10 minutes to check claims and eligibility by phone. 

Not sure how to check claims and eligibility or — gasp! — not registered for the provider portal? Check out our three new demos. All three are concise, informative, and easy-to-follow for your convenience.

Recently we published an article about the anatomy of a CPT code. In it, we explained how these digits keep everything clear and consistent for payers and providers. But what about unlisted codes? Some payers have stopped accepting them altogether. Here's why. 

You’ve probably used self-service checkout at the grocery store. You scan your items and their prices come up on the screen. Produce usually has a sticker on it with a code, and when it’s time to ring up the produce, you type in the code. For example, you don’t type in “broccoli,” you type in “4623,” and the computer knows to charge you for broccoli.

Have you ever filed an appeal because a prior authorization (PA) was denied? Of course, you have. We receive an average of 60 appeals requests per month. Many of these appeal requests, especially the ones for prescription drugs, don’t require an appeal for a favorable outcome. In fact, at least half of all prescription drug PAs that are denied for not meeting medical criteria were subsequently approved once we received additional necessary information.