Prior authorization is one of the challenging areas for securing insurance reimbursement for specialty drugs. It constitutes a critical part of the entire insurance claim cycle. Also known as pre-certification, prior authorization is an area that requires special attention from the claimants, especially if specialty drugs are involved. One of its chief aspects is ensuring the medical necessity and appropriateness of the medication (or care, as the case may be), prior to its actual use.

In recent years, a noticeable trend has been to outsource prior authorization for specialty pharmacies to specialists. Few specialty pharmacies are keeping the process confined among in-house personnel. A growing number of them are enlisting the help of dedicated prior authorization experts to enjoy a better claim approval rate and consequently, better collections.

Sun Knowledge is a name that deserves a special mention in this regard. Ever since its inception in 2007, this medical billing & revenue cycle management organization has been winning hearts with their range of cost-effective services. The main aim of Sun Knowledge has always remained to cut down time without compromising on quality. Combined with their streamlined processes, thoroughness and first-hand Payer-side knowledge (the organization also handles claim adjudication processes for some major health insurance companies), Sun Knowledge is currently witnessing a flurry of requests for their prior authorization services.

In a recent development, the company has started to provide prior authorization services for quasi-medical products such as Botox. They are playing a pivotal role in establishing the medical necessity of such products, and are helping pharmacies secure more reimbursements from insurance companies than ever. Botox, despite being widely considered as a cosmetic product, has been associated with proper medical necessity and shown as a reimbursable benefit under the patient’s benefit plan.

Experts are viewing this as a strategic move by Sun Knowledge to woo more clients, and with their rapidly growing popularity, the strategy seems to be paying off well.

For Media Inquiries, Contact -
Alex Marz
Marketing Director, Sun Knowledge
Contact Number: +1-212-243-3237
Email Id: [email protected]