ExactRx’s embedded tool automates the assembly of clean pre-authorization packets for procedural and diagnostic services. Triggered by a case request, whether through fax, e-fax, or an EMR order, the platform scans the patient’s chart, identifies relevant documentation based on CPT and ICD codes and payer-specific medical necessity policies, and flags what’s missing. It evaluates H&Ps, consults, and diagnostics against utilization management criteria, then generates a submission-ready packet for your financial clearance or insurance authorization team. By closing gaps early, it reduces pre-auth delays, minimizes peer-to-peer reviews, and ensures every referral, test, or procedure is fully justified.
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ExactRx’s embedded tool automates pre-service documentation for procedural clearance. It collects labs, consults, and clinical notes directly from the patient’s chart, validates them against gold-standard clinical guidelines (e.g., AAO, AAOS, NCCN, ASA, ACC/AHA) and facility-specific protocols for patient readiness, and drafts clearance notes — whether that’s a pre-operative assessment, infusion checklist, or IVF workup. By surfacing only what’s missing to the care team, including key elements like ASA classification, NPO status, and perioperative medication requirements, it reduces last-minute cancellations, minimizes delays, and ensures more patient time is directed to care.
For organizations that manage billing across multiple practices, such as CBOs and MSOs, ExactRx transforms central billing operations. ExactRx equips practice managers, claims teams, and central business offices with submission-ready documentation bundles, minimizing back-and-forth and accelerating approvals. At the point of service or case completion, the platform scans the patient’s chart, validates documentation against CPT/ICD coding rules and payer policies, and flags any gaps. It cross-checks operative notes, diagnostics, and prior authorizations against utilization and coverage criteria, then auto-generates a submission-ready claims packet. With ExactRx, CBOs can scale seamlessly as they onboard new practices, while maintaining visibility and compliance across providers and locations.
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