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Prior Authorization

Understanding the challenges and the steps to take to overcome them.

The prior authorization process for medical billing can be a complex and time-consuming task, especially for revenue cycle management teams. This is because it involves several steps that must be consistently followed to ensure accuracy of the authorization before treatment. In addition, the complexity of different insurance plans, varying document requirements among payers, difficulty tracking authorizations, and ever-changing regulatory policies can create challenges for revenue cycle managers when completing the prior authorization process.

What Is the Prior Authorization Process

At its core, the prior authorization process involves verifying eligibility information of patients prior to providing services. It also requires revenue cycle management teams to stay informed on insurance carrier policies and procedures in order to accurately assess coverage amounts, benefit limits, as well as other pertinent details that can affect the authorization process. Additionally, revenue cycle managers must ensure that all necessary paperwork is completed and submitted in a timely fashion.

The Challenges

It’s important to note that prior authorization processes vary among insurance carriers and can often be complex, lengthy and labour intensive. While revenue cycle teams strive to keep up with changes in regulations, they are also tasked with ensuring claims aren't denied or underpaid due to incorrect coding or not following proper protocols related to the pre-authorization process.


The prior authorization process is an essential component of healthcare that can make or break operational efficiency and effectiveness for any provider. Understanding the challenges and steps to overcoming them can make patient care more efficient while increasing your bottom line. With the right tools, providers can maximize resources and help create an efficient system. We understand this is a time-consuming task and are here to help equip you with the tools needed to succeed in making it happen efficiently.

patient demographic entry

Patient Demographics Entry


Accurate patient information is critical to establishing benefits and eligibility, obtaining authorization, and error-free claims filing. The impact of inaccurate information can result in increased claim denials, delayed payments, and inaccuracies in health analytics.

Shoreline acts as a barrier to these inaccuracies. We pride ourselves on providing you a team of experts that have years of patient demographics entry experience and specialized training. We take the patient demographics entry process seriously and as a technology driven company, we employ special scrubbing tools to help automate and ensure accurate patient information.

We understand that the demographics entry process is the stepping-stone for all medical records and plays an integral part in insurance claims Shoreline has helped to add thousands of dollars to our client’s bottom line with our Patient Demographics Entry process.

Demographics Information Captured

Patient Contact Information
Patient Policy Information
Medical Records Integration
  Looking to improve your patient demographics entry process? Contact Us!