Medical Prior Authorization

A patient is scheduled for a procedure that needs prior authorization, but nobody's submitted the request yet. Treatment either gets delayed, or it goes ahead and the claim is denied afterward for missing authorization.

Where Authorization Gets Missed

Many medical procedures require payer approval before treatment, and each payer has its own forms, documentation requirements, and turnaround times. Without a dedicated team tracking upcoming procedures and payer requirements, requests get submitted late, approvals expire before the appointment, or the wrong documentation triggers a delay— and treatment stalls or the claim gets denied later.

What We Handle

• Review of scheduled procedures requiring authorization
• Submission of authorization requests with required documentation
• Follow-up with payers on pending authorization decisions
• Tracking of approval expiration dates against scheduled visits
• Re-submission or appeal of denied authorization requests
• Regular status reporting on all pending authorizations

We get authorization handled before the appointment, so treatment isn't delayed and the claim isn't denied later.

How It Works

What Changes When You Hand This Off

Procedures move forward on schedule, claims stop getting denied for missing authorization, and your staff stops chasing payer approvals between patients. Every request is tracked from submission to decision, and every case follows the same HIPAA-compliant workflow trusted across Medgeene's medical revenue cycle management services.