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Timely Patient Referral
Synova aims at handling referrals efficiently and effectively to ensure that patients receive the necessary care while maximizing revenue and minimizing delays or denials. Our RCM team verifies insurance coverage, checks for referral and authorization requirements, and submits authorization requests to the insurance company as needed.
helps with
- Reducing delays in patient care
- Maximizing revenue
- Minimizing claim denials
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Smooth Prior-Authorization
Synova provides a strategic cost-control process where healthcare providers secure prior approval from a healthcare plan before delivering services.
helps with
- Reducing claim denials and rejections
- Improving revenue capture
- Enhancing patient care coordination
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Transparent System Leading to High Quality Metrics
The referrals and authorization modules of Synova are highly transparent. This leads to a seamless flow of information, clear communication, and trust among the members, thereby improving the quality of metrics.
helps with
- Ensuring seamless information flow
- Enhancing communication and trust
- Improving quality metrics
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Reduce Delays and Frustration
Prior authorization processes can be confusing and time-consuming, leading to delays and frustration for both patients and providers. Synova's advanced technology and software modules streamline the process, minimizing confusion and expediting approvals.
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Ensure Clear Communication
Ineffective communication between healthcare providers, RCM teams, patients, and insurance companies can lead to several pitfalls. Synova bridges this gap by implementing secure messaging platforms, standardizing communication protocols and templates, and providing training on effective communication practices.
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Minimize Denial Rates with Evidence-based Support
Incomplete or incorrect submissions can lead to claim denials. We back you with clinical evidence, significantly increasing the chances of approval and reducing the number of denials.
Measurable Impact
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Improved Patient Access to Specialized Care
Synova helps generate referrals and pre-authorization through calls and portals, ensuring efficient and timely processing of referrals and pre-authorization, minimizing delays in accessing necessary healthcare services.
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Enhanced Patient Satisfaction
Improved handling of all patient referrals resulting in patient satisfaction, improved access to care, and increased revenue.
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Improved Outcomes
Efficient referral and authorization management is important to ensure timely access to specialized services, avoid reimbursement delays, and optimize both patient outcomes and financial performance, leading to improved patient care and reduced revenue leakage.
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Revenue Optimization and Cost Control
Prior authorization helps control healthcare costs by ensuring that services are medically necessary and appropriate before they are performed, reducing unnecessary utilization and associated expenses. This further reduces the chances of claim denials.
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Improved Compliance
Synova promotes timely patient referral, ensuring compliance by systematic follow-ups, closing gaps in care, which are especially challenging in large, complex delivery systems.
Identification of Need
The referral process begins when a patient visits a primary care provider (PCP) or a healthcare specialist determines the need for specialized care, services, or consultations.
Referral Order
If a referral is necessary, the provider generates a referral order in the electronic health record (EHR) system. The referral order includes details such as the reason for referral, the specialist or facility being referred to, any relevant medical information, and the urgency of the referral.
Authorization Process
Upon receiving the referral order, our team verifies the patient's insurance coverage and checks for referral and authorization requirements. If the services or procedures require prior authorization from the insurance company, we submit an authorization request along with supporting documentation.
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Approval or Denial
The insurance company reviews the authorization request, assesses the medical necessity, and evaluates if the requested services meet coverage criteria. If approved, the insurance company provides authorization for the services, specifying any conditions, limitations, or requirements.
Referral is a process of directing the patient to a specialized physician (specialist)/facility by the primary care physician (PCP) for definitive treatment. An efficient referral management process can significantly increase patient retention.
A referral is a formal recommendation from a primary care provider (PCP) to a specialist or another healthcare provider for further evaluation or treatment. It acts as a communication tool between providers to ensure coordinated patient care.
Synova’s referral management system is a unique and powerful tool for health providers to keep track of their patient referrals throughout the care continuum. Its main goal is to improve and streamline communication among primary care physicians, specialists, and patients.
Synova’s automation significantly streamlines the referrals and authorizations process by reducing manual entry errors and speeding up the approval process. It checks payer requirements, submit requests electronically, and track the status of requests in real-time.
Prior authorization (also known as pre-authorization) refers to the process of getting a medical service(s) authorized by the insurance payer. It is a cost-control process by which physicians and healthcare providers obtain advance approval from a health plan before a specific service is delivered to the patient to qualify for payment coverage.
Effective communication is vital for ensuring that all parties involved—healthcare providers, patients, and payers—are informed about the status and requirements of referrals and authorizations.
Yes, Referrals and Pre Authorization enable the insurance companies to pay for the services renders. It also allows the patients to attain get high-quality care.
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Accelerated Outcomes
Value-driven Collaboration
Compliance Assurance
Bring a change to your Healthcare Operations
A partnership with Synova gives you an inherent:
Adherence towards federal, state, and organizational compliances, as well as safeguarding patient data.
Sense of ownership and commitment towards providing value.
Focus on speed, accuracy, efficiency, and optimal outcomes.
Sense of security and transparency through periodic reporting and actionable insights.
Connect with our experts for a quick analysis and possibilities.
