prior authorization services
Prior authorization follow-through
Prior authorization is a phone call or a portal that has to happen before the service. We track what is needed, what was submitted, and the number that has to go on the claim.
What we track
The service that needs approval, the payer, the date it was requested, and the status: needed, submitted, approved, or denied. An approved number is stored so it is on the claim. A denial of the authorization is a different problem from a denial of the claim, and we do not mix them up.
Imaging ordered from primary care, procedures in urgent care, and ongoing therapy visits in behavioral health are the usual list. The exact services depend on the payer’s rules for that plan, which we confirm rather than memorize from last year.
What we need from the clinic
The order and the clinical reason. We cannot invent medical necessity. If the note does not say why the study or the extra visits are needed, we ask the provider before we submit the request.
Retro-authorization, when a payer allows it, is a last resort. The goal is an approval number before the patient is scheduled.
Included
- A worklist of authorizations that are not finished
- Status your front desk can see without calling us
- The approval number carried onto the claim
- A clear stop when the payer says no, before the service is rendered
See what your billing is leaving behind
Share monthly totals. We will tell you where the gaps are. No patient information.