Prior AuthorizationServices
Streamlined prior authorization process to reduce delays and improve patient care. Expert prior authorization services with 94% approval rate.
Prior authorization (PA) is one of the most time-consuming administrative burdens in healthcare. Studies show that physicians and their staff spend an average of 14 hours per week on PA requests. MedSure's dedicated prior authorization team handles the entire PA process — from benefits investigation through approval — so your clinical staff can focus on patients instead of payers.
Prior Authorization Solutions
Specialized prior authorization services designed to streamline your workflow.
Key Features
- Authorization request submission
- Status tracking and monitoring
- Appeal management for denials
- Documentation preparation
- Payer-specific requirements management
- Real-time status updates
Benefits
- 94% approval rate
- Average 3-day turnaround time
- Reduced delays in patient care
- Comprehensive authorization management
- Expert handling of complex cases
- 24/7 support and monitoring
How It Works
Our proven process delivers results for your practice.
Benefits & Coverage Verification
Before submitting a PA request, we verify the patient's active coverage, deductible status, and specific authorization requirements for the requested procedure or medication. This prevents wasted PA submissions for non-covered services.
PA Request Submission
We compile the clinical documentation required by the payer — physician notes, test results, imaging reports, and letters of medical necessity — and submit the PA request via portal, phone, or fax per payer preference. Requests are submitted within 24 hours of receiving complete documentation.
Payer Communication & Follow-up
We track every open PA and follow up with payers daily until a decision is received. When additional information is requested, we coordinate with your clinical team immediately to avoid delays. Approval turnaround is logged and benchmarked by payer.
Approval Documentation & Denial Appeal
Approvals are logged with authorization numbers, service dates, and unit limits. Denied PAs are reviewed for appeal. We draft peer-to-peer review requests, write formal appeal letters with supporting clinical evidence, and escalate to external reviews when warranted.
Frequently Asked Questions
Get answers about our Prior Authorization services.
How long does a prior authorization typically take?
Standard PA timelines are 3-10 business days for most payers. Urgent or expedited PAs can be approved within 24-72 hours. We submit all PAs promptly and follow up daily to minimize wait times. Turnaround varies significantly by payer and service type.
What happens if a prior authorization is denied?
We review every denial for appeal viability. Most PA denials can be appealed through a formal appeal letter with additional clinical documentation, or a peer-to-peer review between the treating physician and the payer's medical director. We coordinate the entire appeal process.
Which procedures and services require prior authorization?
Requirements vary by payer and plan, but common PA requirements include: elective surgeries, specialty referrals, advanced imaging (MRI, CT, PET), inpatient admissions, certain medications, and durable medical equipment. We verify requirements for each patient before scheduling.
Can you handle retro-authorizations for emergent services?
Yes. When services are provided without a PA due to emergency circumstances, we submit retrospective authorization requests with appropriate documentation of medical urgency. Success rates for retro-auths vary by payer and clinical circumstances.
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