Prior authorization services
Prior authorization services that get approvals faster.
Outsource prior authorization to HIPAA certified virtual assistants who verify benefits, build medical necessity packets, submit to every payer and follow up until approval. Your team gets back to patients while we manage the paperwork.
No contracts · HIPAA certified · Works inside your EHR · Match in 7 days
★★★★★ 4.9/5 from practice owners · 200+ practices supported
39
prior authorizations per physician each week
Source: AMA 2024 survey
13 hrs
of physician and staff time spent on them weekly
Source: AMA 2024 survey
95%
of physicians say prior authorization delays patient care
Source: AMA 2025 survey
7 days
standard decision window for impacted payers in 2026
Source: CMS rule CMS-0057-F
The basics
What are prior authorization services?
Prior authorization is the approval a health plan requires before it will cover a medication, test, procedure or piece of equipment. Prior authorization services take that work off your staff: a trained team checks whether approval is needed, gathers clinical documentation, submits the request, follows up with the payer and records the result in your EHR.
Our healthcare prior authorization services pair you with a dedicated prior authorization virtual assistant who learns your specialty, your payers and your providers’ preferences, so requests go out complete the first time.
Prior authorization management, end to end
- Checks if each order needs approval, by payer and plan
- Verifies eligibility and benefits before submission
- Builds the medical necessity packet from your chart
- Submits by portal, ePA, fax or phone
- Tracks every request daily until a decision
- Schedules peer to peer reviews and files appeals
- Posts auth numbers and expiry dates to your EHR
The problem
Prior authorization is slowing your practice down.
Physicians complete dozens of requests every week. Without a dedicated process, approvals stall, claims get denied and patients wait.
Denials from missing documentation
Incomplete clinical notes and wrong codes are among the most common reasons requests come back denied.
Delayed or abandoned care
Patients wait days for answers, and some give up on treatment while approvals sit in a queue.
Staff stuck on hold
Hours on payer phone lines and portals pull your team away from the patients in your office.
Rules that keep changing
Every payer has its own forms, criteria and timelines, and they update them constantly.
Our process
How our prior authorization process works.
Eight steps, owned by one dedicated specialist, from the moment an order is placed to the auth number in your chart.
01
Order intake
We pull new orders from your EHR queue and check each payer’s prior authorization list.
02
Benefits verification
Eligibility, plan type, network status and referral rules confirmed before anything is filed.
03
Medical necessity packet
Chart notes, CPT and ICD 10 codes and clinical criteria assembled to the payer’s policy.
04
Submission
Filed the same day through payer portals, electronic prior authorization or fax.
05
Tracking and follow up
Status checked daily, missing information supplied fast, urgent cases escalated.
06
Peer to peer and appeals
Reviews scheduled with talking points for your provider, appeals written and filed.
07
EHR update
Auth number, approved units and expiry date posted so scheduling and billing can proceed.
08
Reporting
Weekly report on approvals, turnaround times and denial reasons, so problems get fixed.
What we handle
Prior authorization solutions for every request type.
Whatever your providers order, our team knows the payer criteria and the documentation that gets it approved.
Medication prior authorization
Specialty drugs, biologics, GLP 1s and step therapy exceptions through CoverMyMeds and pharmacy portals.
Imaging authorization
MRI, CT, PET and nuclear studies, including radiology benefit managers like eviCore and Carelon.
Surgery and procedures
Inpatient and outpatient surgeries, injections and diagnostic procedures with full clinical support.
Infusion and injectables
Buy and bill drugs, J codes, units and site of care requirements handled correctly.
DME and supplies
Durable medical equipment, CPAP, mobility devices and supplies with the right documentation.
Behavioral health
Therapy, IOP, PHP, TMS and psychiatric medication approvals and concurrent reviews.
Urgent and expedited requests
Time sensitive cases flagged and filed as expedited, with same day follow up.
Renewals and reauthorizations
Expiring approvals tracked and renewed before the next visit, so care never lapses.
Denials and appeals
Denial reasons reviewed, peer to peer calls arranged and appeal letters filed on time.
Payers and portals
Fluent in the payers and portals you deal with daily.
Medicare, Medicaid, commercial and Medicare Advantage plans, worked through the portals your team already uses.
- Medicare
- Medicaid
- UnitedHealthcare
- Aetna
- Cigna
- Blue Cross Blue Shield
- Humana
- Anthem
- Tricare
- Molina
- Availity
- CoverMyMeds
- Surescripts
- NaviNet
- eviCore
- Carelon
Why outsource
Why practices outsource prior authorization.
When you outsource prior authorization to a dedicated virtual assistant, you get specialist focus without the cost of a full time hire.
Faster approvals
Requests go out complete on the same day, so decisions come back sooner and procedures stay on schedule.
Fewer denials
Payer specific checks before submission catch missing notes, codes and criteria.
Lower cost than in house
No recruiting, payroll taxes or benefits for a dedicated authorization coordinator.
Time back for your team
Your staff stop sitting on hold and focus on the patients in front of them.
Healthier cash flow
Approved services become clean claims that get paid instead of written off.
Scales with your volume
Add hours or specialists as you grow, without hiring or training.
Compare your options
Outsourced, in house or software only?
Software speeds up submission but cannot argue medical necessity. In house staff cost more and leave gaps. A dedicated virtual assistant gives you both.
What you get
Virtual Assistant Healthcare
In house coordinator
PA software only
Dedicated specialist who knows your practice
✓
✓
✕
Human judgment on medical necessity
✓
✓
Limited
Works inside your EHR and payer portals
✓
✓
Varies
Peer to peer scheduling and appeals
✓
✓
✕
HIPAA certified with a signed BAA
✓
You train them
Varies
No recruiting, payroll or benefits
✓
✕
✓
Covers sick days and turnover
✓
✕
Not applicable
Typical cost
Flat hourly rate
Full salary plus benefits
License plus staff time
2026 rules
Ready for the CMS prior authorization rule.
The CMS Interoperability and Prior Authorization Final Rule (CMS 0057 F) changes how quickly many payers must respond. We track every deadline so nothing slips.
- Decision windows apply to Medicare Advantage, Medicaid and CHIP plans
- Covers medical items and services only, drugs are excluded
- Requests that pass the deadline are escalated with the payer
- Denial reasons logged so resubmissions are stronger
72 hrs
Expedited requests
Decision window for urgent requests from January 2026.
7 days
Standard requests
Decision window for standard requests from January 2026.
Reasons
Specific denial reasons
Payers must explain why a request was denied.
2027
Prior authorization APIs
Impacted payers must support electronic prior authorization APIs.
Specialties
Specialty trained prior authorization specialists.
Each specialty has its own codes, criteria and common denials. We match you with a specialist who already knows yours.
Security and accuracy
Protected health information, handled with care.
Every assistant completes HIPAA certification and hands on training before touching your workflow.
Business Associate Agreement
Signed with your practice before any patient information is shared.
Secure, monitored workstations
Encrypted connections, no local downloads and access only to systems you approve.
Payer and coding training
Specialists train on CPT, ICD 10, HCPCS and payer criteria before going live.
Quality reviews
Regular audits of submissions to keep accuracy high and catch issues early.
Getting started
Outsource prior authorization in four steps.
01
Free workflow review
We look at your request volume, top payers, denial reasons and current turnaround.
02
Match in 7 days
Meet prior authorization specialists experienced in your specialty and pick your fit.
03
Onboard to your systems
Secure access to your EHR and payer portals, plus your rules for urgent cases.
04
Go live with reporting
Your specialist starts on your queue and you receive weekly performance reports.
Pricing
Prior authorization pricing with no contracts.
Choose a dedicated specialist or part time support. Every plan is a flat hourly rate that covers all payers, portals and request types, quoted after a free workflow review.
Part time PA specialist
For lower volume or a single location.
Custom quote
- 20 hours a week
- Submission, tracking and follow up
- Weekly status report
- Dedicated account manager
MOST POPULAR
Full time PA virtual assistant
One dedicated specialist on your queue.
Custom quote
- 40 hours a week on your schedule
- End to end prior authorization management
- Peer to peer and appeals
- Dedicated account manager
PA team for groups
For multi provider and multi location groups.
Custom quote
- Two or more dedicated specialists
- Specialty and payer focused desks
- Backup coverage included
- Monthly performance review
Every plan includes HIPAA certified specialists, a signed BAA and no long term contract.
Stop letting prior authorizations delay care.
Book a free workflow review and meet your matched prior authorization specialist within 7 days.
Client stories
What practice owners say.
★★★★★ Rated 5 out of 5
“Andrea is doing great. I have been regularly checking in with her.”
AR
Dr. Angie Rumaldo
Provider, True Pursuit
One dedicated assistant, checked in on every week.
Providers work with the same assistant every day, and our team reviews performance with you regularly.
Questions
Prior authorization services FAQs.
Still have questions?
Tell us about your request volume and we will answer in one business day.
What are prior authorization services?
Prior authorization services manage the approvals health plans require before covering medications, imaging, procedures and equipment. A trained team checks requirements, gathers clinical documentation, submits requests, follows up with payers, handles appeals and records each approval in your EHR.
What does a prior authorization virtual assistant do?
A prior authorization virtual assistant is a dedicated remote specialist who works your authorization queue every day. They verify benefits, build medical necessity packets, submit through payer portals or ePA, track status, schedule peer to peer reviews and post auth numbers to your EHR.
Why should my practice outsource prior authorization?
Outsourcing prior authorization gives you a trained specialist without the cost of a full time hire. Requests go out complete and on time, denials drop, and your in house staff spend their day on patients instead of payer phone lines.
How does prior authorization management work with your team?
We pull new orders from your EHR, confirm whether each one needs approval, prepare and submit the request, follow up daily and update your chart with the decision. You get a weekly report on approvals, turnaround and denial reasons.
How long does prior authorization take?
It depends on the payer and the request. Under the CMS rule that began taking effect in January 2026, Medicare Advantage, Medicaid and CHIP plans must decide expedited requests within 72 hours and standard requests within 7 calendar days for medical services (drugs are excluded). We submit the same day so the clock starts as early as possible.
Do you handle denials, appeals and peer to peer reviews?
Yes. We review every denial reason, schedule peer to peer calls with talking points for your provider, and prepare and file appeal letters with the supporting documentation.
Which payers and portals do you work with?
We work with Medicare, Medicaid, commercial and Medicare Advantage plans, including UnitedHealthcare, Aetna, Cigna, Blue Cross Blue Shield, Humana and Anthem, through Availity, CoverMyMeds, NaviNet, eviCore, Carelon and each payer’s own portal.
Will your specialists work inside our EHR?
Yes. Your specialist works in the EHR and portals you already use, with access you control. There is no new software for your team to learn.
Are your prior authorization services HIPAA compliant?
Yes. Every assistant completes HIPAA certification and hands on training before touching your workflow, works on secured workstations and we sign a Business Associate Agreement with your practice.
How much do prior authorization services cost?
We charge a flat hourly rate for a dedicated part time or full time specialist, with no long term contracts. Book a free workflow review and we will quote based on your request volume and specialty.
Related services
More support for your practice.
Get started
Get a free prior authorization workflow review.
Tell us about your request volume and top payers. We will show you where approvals stall and match you with the right specialist.
- Free review, no obligation
- No long term contracts
- HIPAA certified, BAA signed
Request your free review
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