EndoGastric Solutions (EGS) has a dedicated team of specialists to help your GERD patients communicate the value of the TIF procedure to key decision-makers at commercial payers at your third party payers. The goal of the team at EGS is to help your patients gain authorization and reimbursement for your services. This process familiarizes payers with the TIF procedure and, over time, works to expand medical policy coverage.
EGS offers two levels of services:
- Consultative Services: EGS provides the tools and training that enables practices to complete their own pre-determinations.
- Support Services: EGS works in partnership with the practice to execute pre-determinations and all levels of internal and external appeal.
Support Services involve the following:
- Pre-Authorization including Pre-Determination: EGS offers a full-service TIF Authorization Assistance Program, which includes launching a pre-authorization and pre-determination request. This process ensures the payer reviews the patient’s medical necessity and individual health benefits prior to surgery.
- Internal Appeal: If a pre-authorization is denied, our goals as a certification team are to get the patient through all levels of internal appeal as quickly as possible and to communicate concisely with all stakeholders involved in the process. Our practice advocates will assist by providing individualized appeal letters, proactive payer follow-up and support, as well as talking points for peer review.
- External Medical Review: EGS supports the practice and patient through an external medical review by providing process guidance to the patient, talking points for review and a medical literature archive.
At EGS, we are dedicated to advancing surgical intervention for the treatment of GERD. Together, we can educate payers on the limitations associated with open and laparoscopic surgery and help them better understand the benefits of an incisionless approach to fundoplication. We stand ready to assist you and help your patients gain access to the most appropriate therapy.
For authorization assistance, contact us at: