Prior authorization services
Prior authorization services that keep care and payments on schedule
(Company Name) handles prior authorizations from start to finish: we identify what needs approval, submit complete requests with the right clinical documentation, and follow up with payers until you have an approval in hand.
Authorization tracker
Request submitted
Payer portal, same day as the order
Clinical notes attached
Diagnosis, history and medical necessity
Payer review
Followed up daily until a decision
Approved
Auth number, units and valid dates recorded
Example of how every authorization is tracked from request to approval.
The prior authorization problems practices face every week
Prior authorization is one of the biggest administrative burdens in healthcare today. When it isn’t managed carefully, it delays patient care and costs your practice revenue.
Delayed procedures and treatments
Every day spent waiting on a payer is a day your patient waits for care, and appointments get pushed or cancelled.
Denials for missing authorization
When an authorization is missed or expired, the claim is denied after the service is already performed, often with no way to appeal.
Requests rejected for missing documentation
Incomplete clinical notes or wrong codes lead to pended or denied requests and another round of back-and-forth.
Every payer has different rules
Requirements, forms and portals change by payer, plan and service. Keeping track of them all is a full-time job.
Clinical staff pulled away from patients
Nurses and medical assistants lose hours each week to payer calls, faxes and portal uploads.
Expired or exhausted authorizations
Approved units and dates run out quietly, and services delivered after that point go unpaid.
Our complete prior authorization service
We manage the whole authorization lifecycle, not just the submission. From the moment a service is ordered until it is approved and recorded, our team owns every step.
You get fewer delays for patients, fewer authorization-related denials and a clinical team that can focus on care.
- Checking whether a service needs authorization, by payer and CPT code
- Collecting clinical notes, test results and medical necessity details
- Completing payer-specific forms and portal submissions
- Electronic, portal, fax and phone submissions
- Daily follow-up on pending requests
- Peer-to-peer review scheduling with your providers
- Reconsiderations and appeals for denied requests
- Recording auth numbers, approved units and valid dates in your system
- Tracking expirations, visit limits and renewal dates
- Retro-authorization requests where payers allow them
- Referral management for HMO and gatekeeper plans
- Weekly status reports on pending and approved requests
Our prior authorization process
A clear, tracked workflow so no request is forgotten and no service goes unapproved.
Step 1
Identify requirements
We review orders and the schedule to find every service that needs prior authorization.
Step 2
Gather documentation
We collect the clinical notes, diagnosis codes and records that prove medical necessity.
Step 3
Submit the request
We submit through the payer’s preferred channel: ePA, portal, fax or phone.
Step 4
Follow up daily
We track every pending request and respond quickly to payer questions.
Step 5
Record and monitor
Approvals are recorded in your system, with expiry dates and units tracked for renewal.
Services we obtain authorizations for
Our team handles prior authorizations across specialties and service types, including the ones payers scrutinize most.
Advanced imaging
MRI, CT, PET and nuclear medicine studies.
Surgeries and procedures
Inpatient and outpatient surgical procedures.
Specialty medications
Specialty drugs, injectables and biologics.
Infusions and injections
Infusion therapy and in-office injections.
Therapy services
Physical, occupational and speech therapy visits.
Durable medical equipment
DME, orthotics and supplies.
Genetic and lab testing
Genetic, molecular and specialty lab tests.
Sleep studies
In-lab and home sleep testing.
Behavioral health
Therapy, psychological testing and intensive programs.
Cardiology services
Echocardiograms, stress tests and cardiac procedures.
Inpatient admissions
Planned admissions and continued-stay reviews.
Home health and hospice
Home health and post-acute care services.
What your practice gains
A dependable prior authorization process protects both your patients’ care and your revenue.
Care stays on schedule
Approvals are secured before the appointment, so patients aren't rescheduled.
Fewer authorization denials
No more claims denied because an authorization was missing, wrong or expired.
Clinical staff back with patients
Your nurses and MAs stop spending hours on payer calls and paperwork.
Complete visibility
See every pending, approved and denied request in one weekly report.
Protected revenue
Every authorized service can be billed and paid without avoidable delays.
Better patient experience
Patients start treatment sooner and hear fewer "we're waiting on your insurance" calls.
Why practices trust (Company Name) with prior authorizations
Authorizations need persistence, payer knowledge and clinical understanding. Our team brings all three to every request.
- Specialists who know payer rules, forms and portals
- Requests submitted the same day the order is received
- Complete, well-documented submissions that reduce pended requests
- Daily follow-up until a decision is made
- Urgent and expedited requests handled with priority
- HIPAA-focused processes and a signed BAA
Payers and benefit managers we work with
We submit and follow up with government plans, commercial payers and third-party benefit managers.
Medicare Advantage
Medicaid and managed Medicaid
Commercial plans
Blue Cross Blue Shield plans
Radiology benefit managers
Pharmacy benefit managers
TRICARE
Workers' compensation
Related medical billing services
Prior authorization works best alongside these services across your revenue cycle.
Eligibility verification
Coverage and benefits confirmed before every visit.
Medical coding
Accurate CPT and ICD-10 codes that support medical necessity.
Denial management
Denials analyzed, corrected and appealed, with root causes fixed.
A/R follow-up
Persistent follow-up until every claim is paid.
Prior authorization FAQs
Common questions about prior authorization and how our service works.
What is prior authorization in medical billing?
Prior authorization, also called pre-authorization or pre-certification, is approval from a health plan before a specific service, procedure or medication is provided. Without it, the payer may deny the claim even if the service was medically necessary.
Which services usually require prior authorization?
Common examples include advanced imaging such as MRI and CT, surgeries, specialty medications, infusions, durable medical equipment, therapy visits, genetic testing, sleep studies and some behavioral health services. Requirements vary by payer and plan.
How long does prior authorization take?
It depends on the payer and the service. Some requests are approved within a day, while others take several business days or longer. Submitting complete documentation the first time is the best way to avoid delays.
What happens if a prior authorization is denied?
We review the reason for denial, gather any missing information, arrange a peer-to-peer review with your provider if needed, and submit a reconsideration or appeal.
Can you handle urgent or expedited requests?
Yes. Urgent requests are prioritized and submitted as expedited where the payer allows it, with close follow-up until a decision is made.
Do you track authorization expiry dates and visit limits?
Yes. We record approved units, visits and valid dates in your system and alert your team before an authorization runs out, so renewals are requested in time.
Can I outsource only prior authorizations?
Yes. Prior authorization is available as a standalone service or as part of full revenue cycle management.
Get approvals faster and stop authorization denials
Let our team handle your prior authorizations from request to approval. Start with a free review of your current workflow.