Prior Authorization — 98% Approved, Zero Treatment Delays

Proven Results

• 98% Authorization Approval Rate
• 60% Faster Processing Time
• $2.8M Average Annual Savings
• 99% On-Time Service Delivery

Common Challenges

Authorization Denials

Services rendered without proper authorization result in automatic denials, leaving practices unable to collect payment for care already provided.

Processing Delays

Manual authorization requests take 7-14 days on average, causing treatment delays and potential patient dissatisfaction or abandonment.

Missing Documentation

Incomplete or incorrect authorization requests result in denials, requiring resubmission and further delaying patient care and reimbursement.

Tracking Failures

Without systematic tracking, authorization expiration dates are missed, resulting in denied claims for services performed after expiration.

Staff Overwhelm

Administrative staff spends hours on hold with payers, pulling them away from other critical tasks and creating bottlenecks.

Urgent Case Delays

Emergency and urgent cases requiring expedited authorization face delays when standard processes are followed, compromising patient care.

Our Solutions

Proactive Authorization Tracking

Comprehensive system monitors all authorization requirements by payer and procedure, ensuring requests are submitted well before service dates.

• Automated payer requirement identification
• Procedure-specific tracking by specialty
• Proactive submission 7-14 days before service
• 98% authorization approval rate

Expert Submission Management

Experienced authorization specialists prepare complete, accurate requests with all required documentation to maximize first-time approval.

• Certified specialists handle all submissions
• Complete clinical documentation gathering
• Payer-specific form completion
• 60% faster approval turnaround

Real-Time Status Monitoring

Continuous tracking of all pending authorizations with proactive follow-up and escalation ensures nothing falls through the cracks.

• Daily status checks on pending requests
• Automated payer portal monitoring
• Strategic escalation for delayed approvals
• Expiration alerts prevent claim denials

Payer Relationship Management

Direct payer contacts and relationships enable faster processing, expedited urgent requests, and higher approval rates.

• Dedicated payer representative contacts
• Expedited processing for urgent cases
• Appeals support for denied authorizations
• Higher approval rates through relationship leverage

Service Features

Authorization Request Submission

Complete preparation and submission of all authorization requests with comprehensive supporting documentation.

• Payer portal submissions
• Fax and phone requests
• Clinical documentation gathering
• Procedure justification

Real-Time Status Tracking

Continuous monitoring of all pending authorizations with proactive follow-up to ensure timely approvals.

• Daily status monitoring
• Automated payer checks
• Proactive payer follow-up
• Approval confirmation

Expiration Management

Systematic tracking of authorization expiration dates with alerts and renewal management to prevent service disruption.

• Expiration date tracking
• Automated renewal alerts
• Extension request management
• Multi-visit authorization tracking

Denial Appeals & Peer-to-Peer

Expert management of authorization denials including peer-to-peer reviews and appeal submission.

• Denial reason analysis
• Clinical appeal preparation
• Peer-to-peer coordination
• 70% denial overturn rate

Retroactive Authorization Recovery

Specialized services to recover revenue from emergency and services provided without prior authorization.

• Emergency service recovery
• Clinical documentation support
• Timely filing management
• 70% retro auth success rate

Related Billing Resources

• Eligibility Verification
• Denial Management
• AR Management
• Oncology Billing
• Rheumatology Billing
• CPT Codes Reference Guide
• ICD-10 Codes Reference

Key Services

• prior authorization
• pre-authorization
• medical authorization
• authorization management
• insurance authorization
• pre-cert services
• authorization tracking
• retroactive authorization
• retro auth

Related Resources

• Eligibility Verification — Verify coverage before requesting authorization for optimal workflow.
• Denial Management — Prevent authorization-related denials through proactive management.
• AR Management — Recover outstanding revenue from authorization-related denials.