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Eden Connectivity Summary Eden is Aetna's preferred EDI submitter of batch claims Transactions Eden offers the following electronic transactions*: Real-Time: ? Eligibility Inquiry ? Referral ? Referral

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What is precertification and referral software?

Precertification and referral software is a type of software that helps manage the process of obtaining approval for medical procedures or referrals from insurance companies or healthcare networks. It automates the verification of coverage, submission of preauthorization requests, and tracking of referrals to streamline the process and reduce administrative burden.

Who is required to file precertification and referral software?

Healthcare providers, such as hospitals, clinics, and doctors' offices, are typically required to use precertification and referral software to ensure proper authorization and documentation for medical procedures and referrals. Insurance companies and healthcare networks may also use this software to manage the approval process from their end.

How to fill out precertification and referral software?

Filling out precertification and referral software typically involves entering patient information, details of the medical procedure or referral, insurance information, and any supporting documentation. The software may have a user-friendly interface with input fields and dropdown menus to guide the user through the process. It may also include features like real-time eligibility verification and automated communication with insurance companies or healthcare networks.

What is the purpose of precertification and referral software?

The purpose of precertification and referral software is to streamline the approval process for medical procedures and referrals. It helps healthcare providers ensure that the necessary authorizations are obtained before providing services, reducing the risk of claim denials or delays in reimbursement. It also saves time and improves efficiency by automating tasks such as eligibility verification, documentation submission, and communication with insurance companies or healthcare networks.

What information must be reported on precertification and referral software?

The information reported on precertification and referral software typically includes patient demographics, insurance details, healthcare provider information, details of the medical procedure or referral, supporting documentation (such as medical records or test results), and any additional notes or comments related to the request. The software may also store historical data for reference and audit purposes.