Prior Authorization Services

Prior authorization is where clinical time turns into paperwork. Every payer keeps its own list of services that need approval, the lists change, and the request has to carry the right clinical details or it comes back pended. Meanwhile the patient is waiting and your staff are on hold.

Our prior authorization services take that work off your team. We check whether a service needs authorization, file the request with the documentation the payer asks for, follow it to a decision, and track the approval so the claim matches it.

What we handle

• Requirement checks against the patient's plan and the payer's current list, before the service is scheduled.
• Request submission through the payer portal, fax or phone, with the notes, imaging and history the payer's policy calls for.
• Follow-up on pended requests and requests for more information, so they do not stall.
• Peer-to-peer scheduling when a request is denied and the physician wants to speak to the payer's reviewer.
• Approval tracking: codes, units, dates, rendering provider and site of service, recorded where your schedulers can see them.
• Renewals and extensions filed before an approval runs out, not after.

An approval has edges

An authorization is not a general yes. It covers specific procedure codes, a number of units or visits, a date range, a rendering provider and often a place of service. A claim that steps outside any of those is denied even though "we had an auth."

The common ones: a procedure that changed during surgery to a code that was not approved, a series of therapy visits that ran past the authorized count, an MRI that moved to a different facility, or a treatment date that slipped past the approval window. We compare each approval with what is scheduled and what is billed, and flag the gap before the claim goes out.

Decision times are changing

Under a federal rule that took effect in January 2026, Medicare Advantage plans, Medicaid and CHIP programs and some marketplace plans have to answer standard prior authorization requests within seven calendar days and urgent ones within 72 hours, and give a specific reason when they deny. Commercial employer plans are not all covered by the same rule. We track the deadlines that apply to each payer, so a request that has gone quiet gets chased.

Who uses it

Authorization-heavy specialties get the most out of it: imaging, oncology, orthopedics and pain management, sleep medicine, behavioral health and therapy practices with visit limits. It works on its own or as part of full revenue cycle management, where authorization problems are also caught in denial management.