Authorization

At SMH we strive to provide transparency and educate our partners and/or patients we have the privilege of serving when it comes to transportation invoicing.  The horrific stories that facilities or patients have experienced is not a practice we follow and that is why our billing department has developed a track like to call “Life of a Claim”.

In this ever-changing medical billing climate, insurance companies are making it more difficult to join their networks or for providers to request prior authorization in order to exercise medical benefits.  SMH is not in-network with everyone because there is no need to be.  There are certain insurance companies that do not allow new vendor members to join, rather base the EMS transport on medical necessity.  For example, if medical necessity exists based on the history and physical (H and P) or Physician Certification Statement (PCS) on the patient then the process is to submit the claim, and then the insurance carrier will reimburse (i.e. Blue Cross Blue Shield).

Another important task that is critical in this process is insurance verification.  This stage is important to be diligent in gathering patient demographics and proper information upfront to verify the correct insurance information, confirm transportation coverage exists (Part B), and if prior authorization is needed for submission.

When we are verifying insurances, we are confirming that Part B exists because that is where our EMS is categorized.  This allows us to invoice the appropriate party timely and be transparent with the patient or facility we are in contract with.