Service
Spravato Prior Authorization Management
Verification of medical necessity criteria and clinical documentation submission to secure insurance coverage for esketamine treatments.
Insurance coverage for Spravato is contingent on strict medical necessity criteria. Most commercial payers require documented evidence of Treatment-Resistant Depression (TRD) before they approve treatment. This means the patient must have failed at least two or three antidepressant trials of adequate dose and duration in the current depressive episode.
Our prior authorization service manages this process for your clinic. We review the patient’s medical charts to confirm that all required clinical details are documented. We identify gaps in the patient’s history that could trigger a denial.
Operations and Tasks
We contact payers directly to verify specific benefits and copay assistance eligibility. We compile the prior authorization request with the necessary DSM-5 diagnoses, medication history, and clinical notes. We submit the request to the payer and track its status. If a payer requests additional information, we respond immediately to prevent delays in patient care.