Securing prior authorization (PA) for SPRAVATO® (Esketamine) treatment is one of the most critical—and complex—steps in the reimbursement cycle. Providers who lack proper PA processes face delayed treatments, revenue loss, and even compliance risks. That’s why working with a specialized Spravato Billing Company like Finnastra can make a measurable difference in clinical and financial outcomes.
At Finnastra, we have refined our Spravato Billing Services to master the nuances of prior authorization for both commercial and government payers. This article outlines essential strategies we implement to ensure timely approvals and clean claims.
SPRAVATO® is a high-cost, REMS-regulated medication that requires strict documentation before a payer will approve reimbursement. Unlike routine psychotropic drugs, SPRAVATO® requires:
Missing or incomplete documentation can cause delays of weeks or even denials, jeopardizing both patient care and revenue.
Finnastra employs a series of best practices that dramatically increase PA success rates. Our team manages the entire lifecycle of the authorization process—ensuring both speed and accuracy.
We guide providers in using payer-preferred language and documentation to support the diagnosis of TRD. This includes:
Our experience shows that aligning documentation with payer expectations leads to faster turnaround and fewer requests for additional information.
Our billing specialists ensure that all requests include appropriate CPT and HCPCS codes, such as:
These codes are linked with comprehensive documentation that justifies both the use and setting of SPRAVATO®.
Every payer has different PA submission requirements. Some use online portals, while others require faxed forms or phone-based reviews. Finnastra maintains an up-to-date payer database with step-by-step workflows for:
Our payer-specific approach helps eliminate errors, reduce turnaround time, and secure approval on the first attempt.
We don’t simply submit and wait. Our billing team actively tracks every prior authorization request using ticket-based systems and internal SLAs. If a request stalls or nears a decision deadline, we:
This proactive management ensures that treatment is not delayed and revenue remains predictable.
Payers may request medical records post-authorization to validate ongoing medical necessity. Finnastra ensures your documentation is:
This reduces the risk of clawbacks, overpayment reviews, or pre-payment audits.
Our clients consistently achieve over 98% approval rates on initial PA submissions. Here’s how:
By trusting a dedicated Spravato Billing Company, providers can be confident their patients get timely access to treatment while maximizing reimbursement.
Many generic billing companies are unfamiliar with the intricate requirements of SPRAVATO®. Errors in documentation or coding can result in months of delays or full claim denials. In contrast, Finnastra’s Spravato Billing Services are built specifically for this treatment model.
We don’t just know the codes—we understand the full clinical and administrative workflow behind SPRAVATO® authorization and reimbursement.
Partner with a Spravato Billing Company That Knows the Process Inside and Out
If you’re a mental health provider offering SPRAVATO®, you need a billing partner who is as specialized as the treatment itself. Finnastra delivers comprehensive, compliant, and efficient Spravato Billing Services—from eligibility and prior authorization to claims submission and audit support.
Ready to simplify your authorization process and secure better reimbursement?
Visit our Spravato Billing Services page
Or schedule a consultation with our experts today.
