Eligibility & Prior Authorization
Pre-service verification and authorization tracking designed to prevent avoidable downstream denials.
Discuss this service →Address the cause—not only the queue.
Coverage changes and missing authorizations often surface only after care is delivered.
Our first responsibility is to make the workflow visible enough to improve it.
A structured path from assessment to improvement.
Assess the current workflowConfirm systems, ownership, volume, and existing exceptions.
Design the operating playbookTurn scope into documented tasks, cadence, and escalation.
Execute with clear ownershipRun the work with visible status and responsible follow-up.
Review trends and improveReview patterns, prioritize causes, and refine the playbook.
Deliverables your team can see and use.
Specialties with authorization-heavy services, procedures, imaging, or recurring treatment plans.
Progress without unsupported promises.
Measured against an agreed baseline after discovery.
Measured against an agreed baseline after discovery.
Measured against an agreed baseline after discovery.
Measured against an agreed baseline after discovery.
Questions practices ask about Eligibility & Prior Authorization.
Scope, systems, and responsibilities are confirmed during discovery before any operational access is granted.
Coverage, benefit, referral, and authorization requirements can vary by plan. Checking them before service helps the practice route exceptions earlier in the revenue cycle.
Yes. A defined workflow can record the request, payer response, required documentation, expiration details, follow-up owner, and escalation path.
We support the full revenue cycle as well as focused engagements such as billing, coding reviews, denial follow-up, credentialing, eligibility, and prior authorization. Scope is documented before onboarding.
The assessment begins with your existing workflow and technology. We confirm system access, clearinghouse requirements, interfaces, and responsibilities before proposing a transition plan.
See how this fits your current workflow.
Start with a business-level conversation. Secure data exchange comes later, if needed.