Prior authorization operations
Prior Authorization & Pre-Authorization Coordination
Prior authorization is a collaboration between scheduling, clinical documentation and payer administration. We help establish a consistent workflow for requirements, approved submissions, outstanding information requests and resulting determinations, while licensed clinicians retain medical decision-making.
SERVICE CAPABILITIES
What the engagement can include.
Each service is agreed in writing based on your practice's actual needs and systems.
- Procedure and plan-specific authorization requirement screening
- Request intake and submission tracking through authorized payer channels
- Clinical-documentation checklist and missing-item escalation
- Pending, approved, denied or expired authorization status queues
- Authorization validity and visit-limit checks before service dates
- Denial and reconsideration documentation coordination
PRACTICAL QUESTIONS
Frequently asked questions.
Do authorizations guarantee that a claim will be paid?
No. Coverage, coding, documentation, network and contract conditions may still affect payment.
Can your team supply missing medical necessity findings?
No. Our role is administrative tracking and documented communication. Clinical findings and medical necessity decisions belong to appropriate licensed providers.