Prior authorization is the single largest administrative burden in healthcare. Our dedicated auth team manages the entire process from requirement identification through approval tracking, so your providers spend their time on patient care instead of payer phone queues.
Prior authorization has become the number one administrative burden for healthcare providers in the United States. What was designed as a utilization management tool has evolved into a complex, time-consuming process that delays patient care, drains practice resources, and creates a significant source of preventable revenue loss.
The numbers tell a clear story. Physicians and their staff spend an average of 14 hours per week on prior authorization activities. When an auth is denied, 34% of patients abandon the recommended care entirely, representing both a clinical and financial loss. The average cost of processing a single manual authorization is $31 per transaction, a cost that adds up quickly for practices handling hundreds of auths per month.
End-to-end authorization management that covers every step from requirement identification through approval tracking and denial appeals, all handled by specialists who know each payer's criteria and workflows.
We identify which services and procedures require prior authorization based on the specific payer, plan type, and provider network status before the service is scheduled. This proactive check prevents the most common auth failure: discovering the requirement after the service has already been rendered and the claim has been denied.
We submit authorization requests to payers via portal, fax, or phone depending on which channel each payer processes fastest. Every case is tracked from submission to decision with proactive daily follow-up until the auth is approved or an alternative resolution path is identified. No auth falls through the cracks.
When a payer requests a clinical review or peer-to-peer discussion, we coordinate the scheduling between your provider and the payer's medical director. We prepare your provider with the specific clinical criteria the payer is evaluating, the documentation already submitted, and the arguments most likely to result in approval.
Authorizations expire. Treatment plans change. Our team tracks every auth expiration date, monitors remaining authorized units, and submits renewal requests proactively before coverage lapses. For ongoing treatment like behavioral health therapy or orthopedic rehabilitation, this prevents gaps in authorized care that lead to denied claims.
When an authorization is denied, our team does not accept the first answer. We review the denial reason, gather additional clinical documentation, cite the payer's own medical policy and nationally recognized clinical guidelines, and submit a formal appeal. For medical necessity denials, we escalate to peer-to-peer review and, when warranted, to external independent review. Our denial management team supports complex auth appeals with an 85% overturn rate.
Every authorization is tracked from submission to approval in our real-time dashboard. Your team can see pending auths, estimated decision timelines, approved auth numbers with expiration dates and unit counts, and any cases requiring provider action. No more calling us to ask where an auth stands. The information is always available.
A disciplined four-step workflow that identifies auth requirements early, gathers the right documentation, submits through the fastest channel, and tracks every case to resolution.
We identify authorization requirements based on procedure code, payer, plan type, and provider network status before the service is scheduled. Our payer rule database covers 1,500+ payers and is updated continuously as payers change their auth requirements. This upfront check eliminates the most costly auth failure: rendering a service that needed auth but was never requested.
Our team works with your clinical staff to compile the specific documentation each payer requires: chart notes, diagnostic results, treatment history, failed conservative therapy, and clinical rationale for the requested service. We know what each payer looks for and ensure the submission package meets their criteria on the first attempt rather than triggering requests for additional information that delay the decision.
Authorizations are submitted through the fastest available channel for each payer, whether that is an electronic portal, fax, or phone submission. Once submitted, our team follows up proactively on a daily basis until a decision is rendered. We do not wait for the payer to respond. We contact them systematically to move the auth toward resolution and escalate stalled cases to payer supervisors.
Approved authorization numbers are posted directly to your EHR/PM system along with effective dates, expiration dates, approved units or visits, and any payer-specific conditions. Our tracking system monitors remaining units and approaching expiration dates so re-authorizations are submitted before coverage lapses, ensuring continuous auth coverage for ongoing treatments.
While prior authorization affects nearly every medical specialty, certain practice types carry a disproportionate auth burden due to the nature of their services, the cost of their procedures, or the frequency of payer-mandated reviews. Our auth team has deep experience in the payer requirements and clinical criteria for the following high-auth-volume specialties.
Common questions about our prior authorization management services.