📋 Prior Authorization Services

Prior Authorization Management That Protects Revenue and Patient Care

✓ 95% Approval Rate✓ Real-Time Status Updates✓ All Payers✓ Appeal Management
Get Free Consultation →📞 +1 (800) RCM-PROS

Overview

Prior authorization has become one of the most burdensome administrative processes in American healthcare. Denied or delayed authorizations directly impact patient care and your practice revenue.

Rafsons Med Billing prior authorization team manages the entire process from initial submission through approval, denial appeals, and peer-to-peer review coordination. We maintain current authorization requirements for 500+ payers and 30+ medical specialties.

Our proactive approach reduces care delays, prevents revenue leakage from authorization-related denials, and frees your clinical staff to focus on patients rather than paperwork.

Key Benefits & Outcomes

⚡

Rapid Auth Submission

Authorizations are submitted within 2-4 hours of receiving the clinical order, minimizing delays to patient care.

🎯

95% First-Pass Approval

Our payer-specific submission expertise achieves 95%+ authorization approval on first submission.

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Real-Time Status Tracking

Your team receives real-time status updates on every pending authorization so you can schedule patients confidently.

⚔️

Denial Appeals

We fight every inappropriate denial with clinical documentation support and peer-to-peer review coordination.

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Proactive Requirement Updates

Our team monitors payer policy changes and updates authorization requirements before they cause claim denials.

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Authorization Analytics

Monthly reports on approval rates, denial patterns, and average turnaround times by payer and service type.

Our Process

1

Auth Requirement Verification

We determine exact authorization requirements for the specific payer, service, and diagnosis before submission.

2

Clinical Documentation Review

We review clinical notes to ensure supporting documentation meets payer medical necessity criteria.

3

Auth Submission

Complete authorization requests are submitted via payer portal, phone, or fax within 2-4 hours.

4

Approval Tracking

We follow up on pending authorizations and provide real-time status updates to your scheduling team.

5

Denial Appeals

Denied authorizations are immediately appealed with additional clinical support and peer-to-peer coordination.

Frequently Asked Questions

Which services require prior authorization?+
Authorization requirements vary by payer. Common services include advanced imaging, surgical procedures, specialist referrals, DME, home health, physical therapy, and many medications. We maintain current auth requirements for all major payers.
How do you handle urgent authorization requests?+
We have an expedited process for urgent authorizations including same-day submission and direct payer escalation for emergent cases. We also guide your team on the retrospective authorization process for true emergencies.
What happens when an authorization is denied?+
We immediately initiate the appeal process, gather additional clinical documentation, and coordinate peer-to-peer reviews between your physicians and payer medical directors. Our appeal success rate for prior auth denials is over 80%.
Can you help with out-of-network prior authorizations?+
Yes. We manage out-of-network authorization requests and assist with gap exception requests, single-case agreements, and out-of-network reimbursement negotiations.

Eliminate Authorization Bottlenecks

Let our team handle prior authorizations so your staff can focus entirely on patient care.

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