A prior authorization is a deadline. Not a form.
Doctor, the authorization is rarely refused because the care was wrong. It is refused because the request went in thin, or it sat pending and nobody chased it, and the appointment arrived first.
Track the request before the service
Authorization work connects the planned service with payer requirements and supporting documentation. We track the request, follow outstanding items and share the payer response with the practice.
Review requirements
Submit supporting records
Track decision and validity
It sat pending and nobody chased it
Submitted is not approved. A request with no owner sits in the payer queue until somebody calls, and the person who submitted it has moved on to the next thing.
Submitted without the clinical detail
The payer wants conservative treatment tried, imaging attached, or a specific diagnosis documented. Sending the request without it does not get a question back, it gets a denial that has to start again.
Approved, then lost before billing
The authorization number never made it onto the claim, or it expired, or the visit count ran out mid course. The approval existed and the claim was still denied.
How we manage authorizations
Here is what the work looks like, from the first review to the next action.
A defined task.
A documented action.
A visible next step.
Identify what needs one, early
The schedule and the order list are read against payer rules, so the requirement is known while there is still time to obtain approval rather than on the day.
Submit with what the payer asks for
The request goes in with the clinical documentation that payer wants for that service. A complete first submission is faster than two incomplete ones.
Chase to a decision
Pending is not an outcome. Requests are worked on a fixed follow up cadence until there is an approval, a denial or a peer to peer scheduled.
Record it where billing will find it
The approval number, the valid dates and the approved visit count are recorded against the account so the claim carries them automatically.
Watch expiry and visit counts
Approvals expire and courses of treatment run out. Both are tracked so a renewal is requested before the next visit, not after it is denied.
Included in prior authorization management
Agree the scope with your practice, then keep the day-to-day work organized around it.
- Authorization requirements identified from the schedule
- Submission with the required clinical documentation
- Fixed follow up cadence until a decision
- Peer to peer review coordination
- Approval numbers and dates recorded to the account
- Visit count and expiry tracking
- Renewal requested before the course runs out
- Denied requests escalated or appealed
The approval details matter
The authorized service, units, provider and validity window need to align with the planned care. An authorization is not a guarantee of payment, so the claim still needs to meet the applicable requirements.
Submitted, or managed
The work is not the submission. The work is everything after it.
| Situation | Submitted and hoped | How we work it |
|---|---|---|
| Request goes in | Filed, then forgotten | Owned, with a follow up date attached |
| Payer wants more detail | Denial arrives weeks later | Documentation sent with the first request |
| Still pending near the visit | Discovered on the day | Escalated before the appointment |
| Approval granted | Number sits in an email | Recorded against the account for billing |
| Visit count runs out | Next visit denies | Renewal requested ahead of it |
A few things to know before we start
The right scope starts with a clear conversation.
Ask it directly. You will get an answer from somebody who works accounts, not a sales script.
Monday to Friday, 8am to 5pm Central TimeCan you guarantee approval?
No, and you should not trust anyone who does. The clinical decision belongs to the payer. What we control is that the request is complete, on time and chased, which is where most avoidable refusals come from.
Do you handle peer to peer reviews?
We coordinate them: we get the review scheduled and make sure your physician has the payer criteria and the record in front of them. The clinical conversation is yours.
What about urgent cases?
Urgent requests are submitted as urgent and chased on a shorter cycle. Tell us it is urgent and it is treated that way.
Do you work inside our system?
Yes. Authorizations are recorded in your practice management system so your staff and your claims see the same information we do.
Most practices do not buy one service in isolation. These are the ones that change the same numbers.
Find out how many authorizations are sitting pending right now
Tell us your specialty and the billing issue you want reviewed. We will agree the scope and arrange a secure way to share any records needed.