Authorizations fail silently. A request that pends looks identical to one in progress, and the difference surfaces when the service has already been delivered without approval.
Authorizations are a tracked queue with a clock on each item, and you know before the visit whether one is in place.
At a glance
Step 1
Submit authorization requests with the clinical information attached
Step 2
Track every request against a follow-up clock rather than a status field
Step 3
Coordinate peer-to-peer reviews and get them on a calendar
Step 4
Flag services scheduled without an approved authorization in place
What we actually do
- Submit authorization requests with the clinical information attached
- Track every request against a follow-up clock rather than a status field
- Coordinate peer-to-peer reviews and get them on a calendar
- Flag services scheduled without an approved authorization in place
What this fixes
- A spreadsheet of pending authorizations nobody updates
- Peer-to-peer requests that expire because scheduling was nobody’s job
- Procedures performed on an authorization that was never actually approved
We work the claims. You practice medicine.
Coding, claim submission, denial management, and A/R follow-up — with nothing left for your front desk to chase.
View pricingHow It Works
Review
We look at how this runs today and where it leaks.
Scope
A written scope and price before any work starts.
Transition
We take it over without a gap in submission.
Report
The same six numbers every month, so you can see it working.
Prior Authorization — Frequently Asked Questions
Do you handle peer-to-peer reviews?
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We coordinate and schedule them and assemble the clinical information. The review itself is a conversation between your provider and the payer’s.
Are complex authorizations priced differently?
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Yes. A specialty-drug or infusion authorization requiring peer-to-peer is a materially bigger job than an imaging request, and one flat rate for both serves nobody.
How is prior authorization priced?
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It is included in ongoing revenue cycle management, which is priced as a percentage of collections banded by practice size — or as a flat monthly fee in states that do not permit percentage compensation of a billing company. Front-end services are also available on their own, per occurrence, without a billing contract.
Do you guarantee a result from prior authorization?
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No, and nobody honestly can. Coverage, adjudication, payment amounts and appeal outcomes are decided by the payer. What we commit to is the process and the six numbers reported every month, all of which you can reproduce from your own practice management system rather than take on trust.
Can we buy prior authorization without moving all of our billing?
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Front-end services are sold per occurrence and stand alone. The back-end work is harder to separate — denial management without control of coding and submission means inheriting problems created upstream — but we will say plainly which parts make sense on their own rather than sell a partial engagement that cannot succeed.
Ready for books you can actually trust?
Book a free consultation and we will tell you what your revenue cycle needs and what it costs.
- Done-for-you
- Solo or group
- Nationwide
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