How to speed up prior authorizations at a small practice
The agent fills the payer's form from the clinical notes, faxes it, tracks every reply and chases denials so procedures don't slip.
- Reach it by
- Web
- Slack or Teams
- Who can use it
- Your front office, billing staff and clinicians
- Works in
- A HIPAA-compliant fax service · Notes and orders your staff sends · Email
The problem
Every payer has its own form, its own portal and its own idea of what counts as medical necessity. Your staff copies notes, diagnosis codes and test results into each one, then waits on hold to check the status.
When an authorization is late or denied, the procedure gets pushed. The patient is upset, the schedule has a hole in it, and if the visit happens anyway you may not get paid for it.
What your agent does
- A procedure is orderedYour staff sends the order, codes, payer and notes
- Your agent builds the requestPicks out the relevant notes and fills the payer's form
- Your staff reviews itA clinician signs off on anything clinical
- Faxed to the payerThrough a HIPAA-compliant fax service
- Tracked until it's decidedFrom the payer's replies; follow-ups your staff makes in a portal go on their list
- Denials sent back with the reasonDrafts the appeal or peer-to-peer request for your clinician
What you get
- Requests submitted sooner after the order
- Every pending authorization tracked against its procedure date
- Denials worked the same week, with the payer's reason in hand
- Fewer procedures moved because the authorization wasn't back
Who approves what
Your staff reviews every request before it's submitted. Anything that states a clinical fact, and every appeal, is approved by the clinician. The agent never decides what's medically necessary.
Common questions
- Does it work with our EHR or the payer portals?
- Not directly. Most EHRs only let outside tools in through vendor partnerships, and payer portals don't allow automated tools at all. So your staff sends the agent the order and notes, and it does the rest by fax. Anything that has to happen inside a portal goes on your staff's list.
- Who is responsible for what gets submitted?
- Your practice. The agent prepares the request from what's in the chart, and your staff and clinicians review it. It doesn't add clinical details that aren't documented.
- How is patient information protected?
- The agent only sees the systems and records you give it access to and every action it takes is logged. We go over how patient data is handled, and the agreements your practice needs, on the free call before anything is connected.
More for medical & dental practices
Fax referrals
The agent reads each incoming referral fax, preps the patient record, checks coverage, offers the patient times and lets the referring office know.
Eligibility checks before every visit
The day before each visit, the agent checks coverage and copays, and flags problems while there's still time to call the patient.
What job would you hand to an agent?
Book a free 15-minute call. Tell us the job that eats your week and we'll tell you how an agent would handle it and what it would cost.