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.
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.
Streamline Your Workflow
Let us handle the phone calls and paperwork. You handle the patients.