Gastroenterology
Payer administration for gastroenterology practices
Biologic and infusion therapy access, endoscopy and procedure authorization, imaging, referrals, benefits and financial clearance, and the claims and appeals that follow, handled within your systems by Ellery’s U.S.-based team. Your clinicians keep every treatment decision.
What lands on our desk
- Pharmacy-benefit and medical-benefit authorizations for biologics and infusion therapies for inflammatory bowel disease, including benefit determination, step therapy, and renewals
- Authorization for endoscopic and other procedures where the payer or plan requires it, including facility and site-of-service requirements
- Advanced imaging orders where authorization is required
- Referral requirement determination and tracking for consultations, procedures, and infusion visits
- Benefits verification, patient-responsibility estimates, and financial clearance before procedures and infusions
- Manufacturer hub, copay-card, and assistance-program enrollment for specialty medications
- Claim follow-up, underpayment identification, and denial and appeal administration for procedure and drug claims
Administrative demands in gastroenterology
Gastroenterology combines two very different payer workflows. Procedures are episodic: a referral, an authorization where the plan requires one, a facility, and a claim that must match the authorization on file. Inflammatory bowel disease therapy is continuous: a biologic that may process under either benefit, a step-therapy history the payer will ask for, an infusion site the payer may want to control, and renewals on a cycle. A practice that runs both needs each handled in its own rhythm, without either being neglected when the other is busy.
How a case runs here
Ellery Health Partners locates and organizes the documentation the payer’s published criteria require, flags anything missing to your coordinator, submits through the channel your practice approves, monitors status, completes routine payer follow-up, coordinates routine additional-information requests from the record, and records every action, reference number, and outcome in your system. If a request is denied, Ellery Health Partners records the payer’s stated reason, the deadline, and the directed next step, and administers the appeal where that is in scope.
What stays with your practice
Treatment decisions, medical necessity, prescribing decisions, diagnosis and procedure code selection, physician peer-to-peer reviews, provider signatures and attestations, and clinical answers to payer questions remain with your clinicians. When a payer asks a clinical question, Ellery Health Partners documents it and routes it to the contact you designate.
Get started with Ellery Health Partners
Tell us about your practice, your approximate monthly volume, and the support you need. We review your workflow, confirm the scope, and send the agreement and onboarding documents. No patient information is requested or accepted.