Eligibility Verification Services
Administrative checks of coverage and benefits information before appointments, so billing starts from accurate details.
Service
Prior Authorization Services
Administrative coordination of authorization requests: documentation, submission tracking and follow-up.
Overview
About Prior Authorization Services
Some services need approval from the payer before they are scheduled or performed. The request involves forms, supporting documentation from the clinical team and waiting for a response, and it is easy for a request to stall between the people who each hold one piece of it.
We support the administrative coordination of authorization requests. We assemble the information your clinicians provide, submit the request through the payer's required channel, and track it until there is a decision. We do not decide whether a service is medically necessary.
What the work can include
- Identifying whether a scheduled service needs authorization for the patient's plan
- Assembling the documentation your clinical team provides for the request
- Submitting requests and recording reference numbers
- Following up with the payer and recording outcomes and any authorization dates
- Letting the schedulers and clinicians know the status of each request
How it fits with your team
Authorization is a handover between clinical and administrative staff. We keep a visible list of requests and their stage, so a pending request is seen before an appointment date arrives.
Common challenges
Where administrative work tends to get stuck
Practices come to us when routine business tasks start taking more time and attention than they should.
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Work without a clear owner
Tasks are shared between people who are also busy with patients, so follow-up is easy to miss.
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Inconsistent processes
Each person does the same task a little differently, which makes errors harder to spot.
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Scattered documentation
Information sits in email, paper files and separate systems, and is slow to find when it is needed.
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Limited visibility
It is hard to see what is in progress, what is waiting and what needs a decision.
What the support covers
How we support your team with Prior Authorization Services
The exact scope is agreed with you, and it depends on your practice and your systems. In general, our support covers these areas.
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Workflow review
We look at how the work is handled today and agree how it should be handled from here.
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Day-to-day handling
We carry out the agreed tasks on a regular routine, following your instructions and preferences.
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Follow-up on open items
We keep track of work that is waiting on someone, and raise it with you when it needs attention.
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Documentation
We keep notes and records of the work in a consistent format that your team can review.
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Regular updates
We keep you informed about progress and anything that needs your decision.
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Ongoing adjustment
As your needs change, we review the arrangement with you and adjust it.
How it works
How Prior Authorization Services support is set up
A simple, four-step approach that keeps you informed at each stage.
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01
Review
We learn how your practice handles Prior Authorization Services today: your people, systems, payers and priorities.
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02
Configure
We agree what we will take on, how we will work with your systems, and how we will communicate.
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03
Manage
Our team carries out the agreed work on a regular routine and keeps records of what was done.
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04
Monitor
We review progress with you, share what we see and adjust the approach when something changes.
Benefits
What working with us is designed to give you
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Workflow clarity
Everyone knows what is being done, by whom and what comes next.
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Administrative consistency
Work follows defined steps, so it looks the same from one week to the next.
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Better documentation
Records are kept in an organised way that is easy to check and hand over.
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Visibility
Regular updates show you where things stand without you having to ask.
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Operational support
A dedicated team shares the routine workload with your own staff.
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Flexibility
The arrangement can be reviewed and changed as your practice changes.
Who it supports
Support for healthcare businesses
Our Prior Authorization Services support is designed for the people who run healthcare organizations: physicians, medical practices, clinics and healthcare groups.
Specialties we support
Explore the medical specialties this service applies to.
Related services
Other ways we can help
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Denial Management Services
Review of denied claims, correction and resubmission, and appeal-support workflows with clear records.
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Provider Enrollment Services
Payer enrollment applications, status tracking and follow-up for providers joining or changing a practice.
FAQ
Questions about Prior Authorization Services
Answers to questions we are often asked about this service.
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We check the payer's requirements for the patient's plan and tell your team what we find. Clinical decisions stay with your clinicians.
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We record the payer's reason and pass it to your team. Further steps, such as an appeal, are agreed with you. See Denial Management.
Talk to us about Prior Authorization Services
Tell us what your practice needs and we will explain how our support could work.
Please do not include patient information.