What is prior authorization management?
Prior authorization management is the full handling of payer approvals your practice needs before certain procedures, imaging, medications, or referrals can proceed. Our remote team prepares the clinical documentation, submits the request, follows up relentlessly, and manages appeals — closing the loop entirely.
Prior auth is one of the biggest sources of care delays and staff frustration in a practice. Picture Mr. Chen, waiting on an MRI approval. Instead of your nurse spending an afternoon on hold, our specialist tracks it to approval and books him in — days sooner.
From request to approval
Every step our specialists take so authorizations move fast and your clinical team stays off the phone.
We catch what needs approval
When a provider orders imaging, a procedure, a specialty drug, or a referral, our specialist identifies whether the patient's plan requires prior authorization and confirms the exact payer rules that apply.
A complete request, first time
The specialist gathers clinical notes, supporting records, and medical-necessity criteria, then submits through the payer's portal or fax — matching each requirement so the request isn't kicked back for missing information.
No request left in limbo
The specialist monitors every pending authorization, follows up on payer timelines, and escalates anything stalled — so requests don't quietly expire in a queue while a patient waits for care.
A denial isn't the end
If a request is denied, the specialist files the appeal with stronger supporting documentation and coordinates peer-to-peer reviews between your provider and the payer's medical director — recovering approvals that would otherwise be lost.
Approved, documented, done
Once approved, the authorization number and validity dates are recorded in your EHR, the patient is scheduled, and billing has everything it needs — so the claim goes out clean and the service is never at risk of denial.
The whole authorization lifecycle
Requirement checks
We determine exactly which orders need authorization under each patient's specific plan.
Request submission
Complete, criteria-matched submissions through payer portals, fax, or phone.
Payer follow-up
Persistent status tracking and escalation so nothing stalls or expires unnoticed.
Appeals & peer-to-peer
Denials appealed with stronger evidence and clinician-to-payer reviews coordinated.
Medication & radiology auths
Specialty drug, imaging, procedure, and referral authorizations all managed in one place.
EHR documentation
Approval numbers and validity dates logged straight into your system for clean billing.