Authorization requirements are identified by payer and CPT, submitted with supporting documentation, and monitored so approvals are in place when care happens.
Prior Authorization
Authorizations requested, tracked, and attached — before the service is rendered.
- Payer-specific auth rules
- Approval tracking
- Auth-to-claim linkage
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Specialists own every step. Automation handles the repetitive work. Nothing waits in a queue nobody is watching.
Identify
Payer rules by CPT and HCPCS determine which scheduled services need authorization.
Request with documentation
Requests go out by portal, fax, or phone with the clinical documentation each payer expects.
Track
Approvals, units, date ranges, and expirations are tracked to completion.
Link & renew
The authorization is attached to the claim, and renewals start before units or dates run out.
AI-assisted pattern detection and decision support that works alongside our billing professionals — never instead of them.
Decision support identifies services that require authorization by payer and plan.
Expiration and unit-count tracking triggers renewals before they lapse.
Specialists submit and follow up with payers.
Specialty-aligned specialists who know your payer rules.
If it's not here, an RCM specialist will answer it directly.
It depends on the payer and plan. We maintain a requirement matrix for your specialty and keep it current as policies change.
A structured review of denials, A/R aging, coding, and underpayments — findings are yours to keep, whether or not we work together.
- · Findings you keep, whether or not we work together
- · No patient information requested
- · A named RCM specialist, not a sales queue
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