Prior Authorization Services

Prior Authorization Request and Status Coordination

Request Preparation Payer Status Follow-Up Appeal Coordination Workflow Review
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Overview

Prior authorization requirements vary by payer, plan, service, and clinical circumstances. Practices need to identify applicable requirements, assemble supporting documentation, submit requests, and track payer responses.

Rafsons Med Billing can discuss request preparation, status follow-up, appeal coordination, and communication with your practice team.

The payer makes authorization decisions and controls processing times. Confirm requirements and approval status with the payer before services are scheduled or delivered.

Possible Service Activities

Request Preparation

Coordinate payer forms and supporting information supplied by the practice.

Status Follow-Up

Track the request and record payer responses for the practice team.

Status Tracking

Record payer responses and share updates through the communication method agreed with the practice.

Appeal Coordination

Coordinate appeal steps and supporting materials when requested and included in the agreed scope.

Requirement Checks

Check the payer and plan information available for the request; confirm current requirements with the payer.

Authorization Reporting

Agree on reports for submitted requests, pending responses, denials, and unresolved items.

How Work May Be Organized

1

Check the Payer Requirement

Review available payer information for the service and plan, then confirm unclear requirements with the payer.

2

Coordinate Supporting Information

Work with the practice contact to assemble information they approve for submission.

3

Request Submission

Coordinate submission through the channel and process agreed with the practice.

4

Status Tracking

Record payer responses and share updates through the agreed communication workflow.

5

Coordinate Next Steps

Record the payer decision and discuss available next steps with the practice; the payer controls the review.

Frequently Asked Questions

Which services require prior authorization?+
Requirements vary by payer, plan, service, and clinical circumstances. Confirm the current requirement directly with the payer before services are scheduled or delivered.
How do you handle urgent authorization requests?+
Contact us to confirm availability and the agreed process. Urgent handling depends on the request details and payer channel; the payer controls its review time.
What happens when an authorization is denied?+
Options depend on the payer's rules and the case. We can discuss appeal coordination and the documentation the payer requires.
Can you help with out-of-network requests?+
Tell us what request or coordination work you need. We can confirm whether it fits the service scope and the parties’ agreed responsibilities.

Discuss Authorization Workflows

Contact us to discuss request preparation, payer follow-up, and the responsibilities your practice wants covered.

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