What seems like a simple phone call, portal entry, fax review, is, in practice, a complicated process filled with obstacles:
The costs of failing to secure authorizations are steep. Authorization issues are among the top causes of claim denials, costing hospitals millions annually. Even when denials are later overturned, hospitals lose valuable staff time and face cash flow disruption. For patients, delays in authorization can mean prolonged emergency department stays or postponed treatment.
Hospital staff are already stretched thin, balancing discharge planning, patient education communication, MDRs, various meetings, care coordination, etc. Adding the complexities of payor communication often overwhelms them, creating gaps that expose hospitals to lost revenue.
Centralizing all these tasks with bServed helps creates a predictive and effective solution giving staff time and energy to focus on patient-centric tasks. Unlike staffing agencies, expensive registry nurses with little oversite/training or overextended internal teams, bServed delivers:
24/7 coverage to meet payor deadlines across time zones.
Expertise in payor criteria, including insurer-specific rules and national guidelines.
Packet build: Clinical summary + criteria cites + attachments (ED/H&P, labs/imaging, RN note, MD addendum). The packet is only submitted when complete.
If authorization is not received within 24 hrs of admission, then its escalated to payor's management.
Insurance experts with industry knowledge who help hospitals maximize denial prevention
Triggering: ED Registration, IP order/ED admit fires criteria loader + payer routing profile; missing elements (ABG, IV therapy start, failure of outpatient) flagged immediately.
Escalation pathways with physician advisors ready to handle peer-to-peer calls.
Transparent reporting that gives leadership visibility into every step of the process.
Write-back: Approval ID, dates, LOC persisted into EHR; denial auto-spawns appeal packet in < 30 minutes with delta-evidence required.
Payor authorization is not clerical busywork, it is a high-stakes process that directly determines whether hospitals get paid. With its specialized expertise, round-the-clock availability, and integrated escalation pathways, bServed ensures authorizations are secured correctly and on time, protecting both patients and hospital revenue.
By securing authorizations and daily stay justifications, we maximize reimbursement and reduce payment delays.
We manage all communication with payors — portals, fax, calls, and Peer-to-Peer reviews — ensuring timely responses and escalation when delays occur.
You can lower your in-house costs by 60% with bServed’s Utilization Management and Case Management programs.
Payors continually change requirements for stay justification. CMS interoperability deadlines are approaching
bServed – An indispensable partner in lowering health care costs while providing the best patient care.
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