Effective billing management covers the entire prior authorization process — submission, tracking, peer-to-peer coordination, appeals, and renewal — so your schedule keeps moving and every authorized service gets paid. Dedicated PA specialists for all payers and specialties.
Prior authorization (PA) is the process of getting insurance payer approval before delivering a procedure, service, or medication. Without an approved authorization, even a medically necessary service will be denied — costing your practice the revenue and your patient the care. Prior auth volume has increased 20% year-over-year as payers expand required services lists. Practices without dedicated PA staff see their schedules stall, their providers waste clinical time on hold with payers, and their denial rates climb from auth-related denials.
Complete authorization packages submitted on the first request — clinical documentation, physician orders, ICD-10/CPT codes, medical necessity narrative. Fewer pend requests, faster approvals.
Daily tracking of all pending authorizations with payer-specific follow-up protocols. No auth falls through the cracks. Real-time status visible to your scheduling team.
When a payer denies or pends an auth, we schedule the peer-to-peer review, prepare the clinical summary, and coordinate with the physician — minimizing time spent on hold and maximizing overturn rates.
Formal appeal preparation with additional clinical documentation. Level 1 and Level 2 appeals. IRO (Independent Review Organization) submissions when internal appeals are exhausted.
Proactive renewal tracking for ongoing services — physical therapy, home health, DME, behavioral health. Renewals submitted before expiration so continuity of care is never interrupted.
Every claim is matched to its authorization before submission. Auth number included on claim. Prevents "no auth on file" denials for services that were already approved.
We verify the patient's insurance, confirm whether the procedure requires auth for that specific plan, and identify payer-specific criteria before submitting.
We compile all required clinical documentation, write the medical necessity narrative, and package the auth request to meet each payer's first-submission requirements.
Auth submitted electronically or via phone based on payer preference. Daily follow-up calls/portal checks until a decision is received.
If denied, we immediately initiate the peer-to-peer process and coordinate physician scheduling, or prepare the formal appeal package — whichever path has the higher overturn probability.
Auth number logged, service scheduled, claim submitted with auth number attached. No "auth approved but claim denied" because the auth number wasn't on the claim.
Our PA team does nothing but prior auth — they know each payer's criteria, portal, and decision-maker contacts. This beats front desk staff handling auth as a 10th priority.
We maintain updated auth requirement databases for all major payers — what's required, what helps, and what triggers a denial — for the most common procedures in your specialty.
BAA signed before we access any patient information. HIPAA-trained staff. Encrypted communications. Full audit trail on all PA activities.
Physicians spend an average of 2 hours/week on prior auth admin. We take that burden off your clinical staff entirely — they see patients, we handle payers.
A free audit identifies your top prior auth bottlenecks, denial patterns, and how much revenue is at risk from expired or mismanaged authorizations.