Prior Authorization Services
Your clinicians shouldn't spend their evenings on hold with payers. We take the authorization burden off their desks.
Overview
Prior authorization is the most hated administrative task in healthcare for a reason: it's urgent, payer rules change constantly, and a single missed auth can void an entire surgical claim. Practices lose both revenue and staff morale to it.
Our authorization team initiates requests within 24 hours of the order, submits clinical documentation payers actually accept, follows up until a determination is issued, and schedules peer-to-peer reviews when needed. Every active authorization is tracked against its expiration and unit count so care never outruns approval.
What's Included
24-Hour Initiation
Auth requests submitted within one business day of the order or referral.
Clinical Documentation Prep
Requests packaged with the specific clinical criteria each payer's policy requires.
Persistent Follow-Up
Statused every 2–3 business days until approved — no request goes stale.
Peer-to-Peer Coordination
Physician reviews scheduled and prepped when payers push back.
Expiry & Unit Tracking
Approvals monitored so renewals happen before care is interrupted.
Auth Denial Appeals
Denied authorizations appealed with medical-necessity documentation.
Frequently Asked Questions
Advanced imaging (MRI/CT/PET), surgeries, specialty medications, DME, behavioral health programs, and many therapy plans. Requirements vary by payer and plan — part of our job is knowing which combination needs what.
We appeal with targeted medical-necessity documentation and arrange peer-to-peer reviews between your physician and the payer's medical director — the step where most auth denials get reversed.
Yes. Urgent requests are worked same-day through payer expedited channels, which most plans must resolve within 72 hours (and often faster for genuinely urgent care).