Authorization and Referral Management
We obtain and track required authorizations and referrals to prevent delays or denials in care. Our process ensures services are approved in advance and aligned with payer requirements
Pre-Submission & Preparation
Before the patient ever enters the exam room, our team conducts a comprehensive review of payer-specific protocols. We gather all required clinical data, verify procedure codes (CPT) against diagnosis codes (ICD-10), and confirm plan-specific coverage policies. This proactive preparation ensures a smooth submission process and prevents scheduling delays due to missing information.
Referral Management
End-to-End Referral Coordination
We manage the full referral lifecycle—from initial request through specialist scheduling and follow-up.
Closed-Loop Care Tracking
Specialist visits are tracked to ensure consult reports are returned to the referring provider, preventing patient leakage.
Closed-Loop Care Tracking
Specialist visits are tracked to ensure consult reports are returned to the referring provider, preventing patient leakage.
Authorization Assurance
We confirm all specialist services are properly authorized before appointments occur.
Clinical Documentation Review
Payer Utilization Management (UM) criteria can be strict. We meticulously review your clinical notes and patient history to ensure that medical necessity is clearly and sufficiently documented. If gaps exist, we coordinate with your clinical staff to strengthen the documentation, ensuring it aligns perfectly with the payer’s coverage determination policies before submission
Submission & Follow-up
Submission & Follow-up We utilize every available channel, including online payer portals, fax, and direct phone lines, to submit authorization requests immediately. Our team actively tracks the status of every request, following up aggressively with insurance representatives to eliminate processing bottlenecks and secure the approval number well in advance of the scheduled service date.
Resolution & Documentation
We ensure that the valid authorization number, validity dates, and approved CPT codes are accurately entered into your Practice Management system. This precise data entry ensures the authorization maps correctly to the final claim, preventing downstream "No Authorization on File" denials.
Denial & Appeal Management
We aggressively advocate for your payment. We manage the complex appeals process by compiling strong clinical arguments to prove medical necessity and urgency, and we facilitate support for Peer-to-Peer reviews to overturn adverse decisions.
Claims Lifecycle Management
End-to-End Oversight of Every Claim
From submission and follow-up to resolution and appeals, we manage the full claims process to maximize revenue and minimize delays. Our team ensures accurate documentation, timely payments, and effective handling of denials to protect your practice’s financial health.