Medical scheme authorisations.
Authorisations are deadline-bound and document-heavy. What tends to delay them, and what keeps them moving.
An authorisation is the scheme confirming, before treatment, how a planned procedure or admission will be funded. Getting it wrong is expensive in a way that is difficult to unwind afterwards, because the decision point has already passed.
What delays an application
- The application goes out incomplete and the scheme comes back for more
- A request for further information arrives while the practice is at its busiest
- Nobody is tracking which applications are still unanswered
- The clinical detail needed for the motivation sits with someone who is in theatre
What keeps it moving
Completing the application properly before it goes out is worth more than submitting it a day earlier. After that, the discipline is simply knowing what is outstanding: a list of live applications with dates against them, checked on a rhythm rather than when a patient calls to ask.
This article is general information about healthcare administration in South Africa. It is not legal, clinical or financial advice, and it does not describe the rules of any particular medical scheme. Always check the position that applies to a specific claim.