Prior authorizations requested, tracked and on file
We identify which services need prior authorization for each payer, submit the request with supporting documentation, follow up until a decision, and track visits and expiration dates.
What’s included
- Authorization requirement checks by payer and plan
- Submission through payer portals, fax or electronic prior authorization
- Clinical documentation gathered from your EHR
- Follow-up until approval or denial
- Tracking of approved units, visits and expiration dates
- Peer-to-peer and appeal coordination for denials
How we handle it
Identify
Check whether the service needs authorization for that plan.
Submit
Send the request with the right clinical documentation.
Follow up
Track status until a decision is made.
Track
Record approved units and dates so claims match the authorization.
Details that matter
Under the CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F), Medicare Advantage, Medicaid, CHIP and Marketplace plans must send decisions within 72 hours for expedited requests and 7 calendar days for standard requests, starting January 1, 2026. Commercial plans follow their own rules and state laws.
Authorization problems also cause denials after approval: billing more units than approved, or dates of service outside the authorized window. We track both.
Questions about prior authorization
Which specialties need the most authorizations?
ABA therapy, physical and occupational therapy, imaging, DME, home health, behavioral health programs and specialty drugs are common examples.
What if an authorization is denied?
We review the denial reason, gather documentation and coordinate a peer-to-peer review or appeal with your provider.
See where your revenue is going.
Send a few details and we will set up a short call to review your claims, denials and A/R. No cost and no commitment.
We sign a Business Associate Agreement before we handle any patient data.