Prior Authorization Services for Medical Practices
We handle submissions, follow-ups, and appeals so your staff can focus on patients instead of payer portals.
- HIPAA-Compliant
- U.S.-Based Experts
- Free Practice Audit
What Our Prior Authorization Services Include
Authorization Submission
We submit prior authorization requests to payers on the same day we receive the clinical information from your office. Every request is submitted with the correct supporting documentation the first time to minimize back-and-forth with payers.
Status Tracking and Follow Up
We track every open authorization request and follow up proactively with payers before deadlines. You always know the status of pending auths without having to chase anyone down.
Peer-to-Peer Review Scheduling
When a payer denies an authorization on medical necessity grounds and offers a peer-to-peer review, we coordinate the scheduling between your physician and the payer's medical reviewer. These calls are one of the most effective ways to overturn a denial.
Authorization Appeals
If an authorization is denied, we build the appeal with the clinical justification and supporting notes your physician has documented. We know what payers are looking for and how to present the case effectively.
Urgent and Expedited Requests
For time-sensitive situations, we flag and submit expedited authorization requests and follow up aggressively to get approvals as quickly as the payer allows.
Multi-Specialty Coverage
We handle prior authorization management across all major specialties including radiology, cardiology, orthopedics, physical therapy, mental health, oncology, and more.
How Outsourcing Prior Authorization Helps Your Practice
Most practices handle prior authorizations in-house because they assume it needs to be done by someone who knows the patients. In reality, the authorization process is almost entirely administrative. It requires knowing payer requirements, submitting the right documentation, and following up consistently, none of which requires clinical knowledge.
When you outsource prior authorization to us, your front desk gets hours back every week. Auth-related claim denials drop significantly because requests are submitted correctly and followed up on every time. And patients stop getting rescheduled because their authorization is still pending.
How a Request Moves from Order to Approval
01
Check the Requirement
As soon as a procedure is scheduled, we check whether the patient's specific plan requires authorization for that code. Requirements differ by plan, not just by insurer.
02
Build the Request
We assemble the diagnosis codes, procedure codes, and the clinical notes that show medical necessity under the payer's own criteria.
03
Submit and Track
Requests go through the payer's portal, phone line, or fax the same day, and every open request is followed up until there is a decision.
04
Record the Approval
The authorization number, approved units, and valid dates are recorded where your billing team will see them, so the claim goes out with the right number attached.
When Authorization Goes Wrong
A missed or mismatched authorization shows up later as one of a few denial codes. You can look any of them up in our Denial Code Lookup.
| Denial code | What it means | How it is prevented |
|---|---|---|
| CO 197 | Authorization or precertification was never obtained | Requirements are checked when the visit is scheduled, not after the claim is denied |
| CO 15 | The authorization number is missing, invalid, or does not match the service | Approval details are recorded against the exact codes and provider on the claim |
| CO 198 | The service went beyond what was authorized | Approved units and date ranges are tracked, and extensions requested before they run out |
| CO 50 | The payer decided the service was not medically necessary | CO 50: how to win the appeal |
Decision Deadlines Are Now Set by Rule
Under a federal rule that took effect in January 2026, Medicare Advantage plans and Medicaid and CHIP programs must decide standard prior authorization requests for medical services within seven calendar days, and urgent requests within 72 hours. They also have to give a specific reason when they deny a request.
The rule does not cover prescription drugs, and most employer-sponsored commercial plans fall outside it, so turnaround still varies widely. What it changes is leverage: when a covered plan misses its deadline or denies without a clear reason, there is now a standard to hold it to. We track each request against the deadline that applies to it and escalate when a payer runs late.
An approval is also only as good as the coverage behind it. An authorization for a patient whose plan has lapsed is worthless, which is why we pair this work with eligibility verification before the visit, and why denied authorizations feed straight into our denial management process.
Free Denial Tools
Frequently Asked Questions About Prior Authorization Services
Prior authorization is a requirement from insurance payers that certain procedures, medications, or referrals be approved before they are performed. Without an approval in place, the payer can deny the claim entirely even if the service was medically necessary.
It varies by payer but commonly includes imaging studies like MRIs and CT scans, specialist referrals, surgical procedures, durable medical equipment, certain medications, and mental health or substance abuse treatment. We review your specific payer mix and specialty to identify which services need auths most often.
A denial is not always final. We appeal denials with clinical documentation and request peer-to-peer reviews where appropriate. Many denials are overturned on appeal when the right information is presented.
We submit same-day for requests received before our cutoff time. For urgent or expedited requests we prioritize immediately.
Yes. We work with Medicare Advantage plans, Medicaid managed care, and all major commercial payers including Aetna, Cigna, UnitedHealth, Blue Cross Blue Shield, and others.
We work with your office to establish a simple workflow for sending us the relevant clinical notes, diagnosis codes, and procedure details. Most practices get this down to a quick process within the first week of working together.
It depends on the plan and the service. Since January 2026, Medicare Advantage, Medicaid, and CHIP plans must decide standard requests for medical services within seven calendar days and urgent requests within 72 hours. Other plans set their own timelines, and requests that arrive with complete clinical documentation are decided fastest.
The claim is usually denied, most often with denial code CO 197, and many payer contracts do not allow the practice to bill the patient for it. Some payers accept a retroactive authorization request in limited situations such as emergencies, but it is never guaranteed, which is why the requirement should be checked when the service is scheduled.
Related Services
Eligibility Verification
Confirm coverage before requesting approval
Denial Management
Denial analysis, appeals, and prevention
Revenue Cycle Management
The full cycle, managed as one process
Medical Billing Services
End-to-end billing for independent practices
Medical Billing and Coding
Certified coding that holds up to payer review
Provider Credentialing
Payer enrollment handled end to end
AR Management
Aged AR recovery and payer follow-up
Outsource Medical Billing
Compare in-house and outsourced billing costs
Streamline Your Workflow
Let us handle the phone calls and paperwork. You handle the patients.