In the intricate world of healthcare management, pre-authorisation stands as a vital checkpoint ensuring timely access to necessary medical interventions and prudent cost control.

At MSO International, our pre-authorisation process is a beacon of efficiency and transparency, meticulously orchestrating the journey of in-patient and high-value out-patient cases through our network.

Whether it’s online, telephonic or via email, our dedicated Call Centre, supported by local offices where needed, ensures that every pre-authorisation request is handled promptly and with the utmost care.

In this blog, we unpack the pre-authorisation process at MSO International.

Let’s get started.

Ensuring quality care and cost control

• All in-patient and high value out-patient cases through the Network are pre-authorised by the relevant provider with MSO International prior to care (where possible).
• In the event of an emergency, such cases are authorised within 48 hours of admission.
• Pre-authorisations occur either online, telephonically or via email through the MSO International Call Centre, facilitated by the local MSO International office in certain circumstances
• This process provides assurance to the provider in terms of the credit extension they are granting, while at the same time offering MSO International the ability to control costs and ensure appropriate utilisation on the scheme

What procedures require pre-authorisation with MSO International?

Pre-authorisation is required for all in-hospital procedures and high-cost medical interventions, including but not limited to radiological investigations and gastrointestinal (GI) scopes.

What does the pre-authorisation process entail?

The pre-authorisation process is a crucial step in ensuring the appropriate utilisation of healthcare resources. It involves a thorough assessment of medical necessity and adherence to evidence-based clinical protocols. Additionally, pre-authorisation includes confirming the coverage of benefits under the member’s plan.

How is the pre-authorisation process managed?

MSO International operates a dedicated 24/7 multilingual contact centre to facilitate the pre-authorisation process. This contact centre serves as a vital point of contact for both members and healthcare providers. Trained professionals are available round-the-clock to assist in pre-authorizing procedures, ensuring compliance with established protocols and guidelines.

What benefits does the multilingual contact centre offer?

The multilingual nature of the contact centre ensures accessibility and support for individuals from diverse linguistic backgrounds. Members and providers can communicate their pre-authorisation requests and inquiries in their preferred language, enhancing clarity and understanding throughout the process.

How does pre-authorisation benefit members and providers?

Pre-authorisation helps members make informed decisions about their healthcare needs while ensuring that treatments are medically necessary and aligned with evidence-based practices. For providers, pre-authorisation streamlines the reimbursement process, mitigates financial risks and promotes transparency in healthcare delivery.

What happens if a procedure is not pre-authorised?

Failure to obtain pre-authorisation for applicable procedures may result in coverage denial or reduced benefits. However, MSO International understands that emergencies can arise, and exceptions may be made in such cases. It is important for members and providers to communicate with MSO International promptly to address any urgent healthcare needs.

Can members and providers track the status of pre-authorisation requests?

Yes, MSO International provides tools and resources for tracking the status of pre-authorisation requests. Members and providers can access online portals or contact the multilingual contact centre to inquire about the progress of their requests and receive timely updates.

If you have further questions about the pre-authorisation process or need assistance, please reach out to our support team. We are committed to ensuring a smooth and efficient healthcare experience for all stakeholders.