Fast, Accurate, & Fully Managed Prior Authorization Service

We begin every request with a complete insurance eligibility and benefits check to ensure accuracy from the start. This includes:

• Active insurance coverage verification
• Plan type review (HMO, PPO, Medicare Advantage, Medicaid)
• Referral and authorization requirements
• Deductibles, copays, and out‑of‑pocket costs
• Payer‑specific rules for CPT/HCPCS codes

We identify whether prior authorization is required for all services ordered by your practice, including:

• Diagnostic imaging (CT, MRI, PET, ultrasound, X‑ray, advanced imaging)
• Specialty and diagnostic testing (sleep studies, cardiac testing, neurological testing, lab work, and more)
• In‑office, outpatient, and surgical procedures across all specialties
• Biologics, injectables, and specialty medications
• Durable Medical Equipment (DME) and medical supplies
• Therapy, rehabilitation, and specialty care programs

Our team reviews payer policies, medical necessity criteria, and coding requirements to ensure every request is submitted correctly.

We gather and prepare all required clinical documentation to support each authorization request, including:

• Office visit notes
• Diagnostic results and imaging reports
• Medication history and failed therapies
• Treatment plans
• Supporting clinical evidence

We submit prior authorization requests through the appropriate payer portals, including:

• Availity
• NaviNet
• UnitedHealthcare, Aetna, BCBS, Cigna, Humana portals
• CoverMyMeds for medication authorizations

Every submission is tracked and documented for full transparency.

We monitor each request until a final determination is issued. Our team:

• Performs timely follow‑ups
• Responds to payer requests for additional information
• Communicates updates to your practice
• Documents all activity for compliance and billing

Once a decision is made, we provide:

• Authorization numbers
• Validity dates
• Required modifiers or notes
• Updates for your EMR and billing team

If a request is denied, we prepare and submit appeals with supporting documentation to protect your revenue.