Patient Access Services

Prior Authorization Services

Prior Authorization is a critical function within Patient Access Services that involves obtaining approval from insurance payers before specific medical services, procedures, or treatments are rendered — ensuring services are medically necessary, covered, and eligible for reimbursement.

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Overview
Payer Approval Before Every Service

Prior Authorization is a critical function within Patient Access Services that involves obtaining approval from insurance payers before specific medical services, procedures, or treatments are rendered.

Timely and accurate authorization ensures services are medically necessary, covered under the patient's plan, and eligible for reimbursement — protecting both the provider's revenue and the patient's financial interests.

Objectives of Prior Authorization

  • Ensure payer approval before services are performed
  • Prevent claim denials due to missing or invalid authorizations
  • Confirm medical necessity as per payer guidelines
  • Support timely patient scheduling and care delivery
  • Improve revenue cycle efficiency and cash flow
Key Activities
End-to-End Authorization Workflow
Our authorization specialists manage every step of the prior authorization process — from requirement identification through final approval and documentation.

Requirement Identification

  • Review insurance benefits to determine authorization needs
  • Identify services, procedures, diagnostics, or admissions requiring approval
  • Confirm requirements for inpatient, outpatient, and specialty services

Request Submission

  • Submit authorization requests via payer portals, fax, or phone
  • Provide complete clinical documentation and supporting medical records
  • Ensure correct CPT, ICD-10, and provider details are included

Tracking & Follow-Up

  • Track authorization status and turnaround times
  • Perform follow-ups with payers to avoid delays
  • Address additional documentation or clinical review requests

Authorization Documentation

  • Record authorization numbers, validity dates, and service limits
  • Update authorization details in PM/EHR systems
  • Communicate authorization status to scheduling and clinical teams

Coordination & Communication

  • Collaborate with providers, clinical staff, and case management teams
  • Inform patients about authorization status and potential delays
  • Escalate urgent or denied cases for reconsideration or appeals
Tools & Systems Used
Integrated Authorization Technology

Payer Authorization Portals

Direct submission and status tracking

Practice Management Systems

Scheduling and workflow integration

Electronic Health Records

Clinical documentation and records access

Fax & Payer Call Centers

Multi-channel submission capabilities

Compliance & Quality Standards
Regulatory-Compliant Authorization Workflows

Payer-Specific Policies

Strict adherence to each payer's unique authorization policies and requirements

HIPAA Compliance

HIPAA-compliant handling of all patient health information throughout the process

Audit-Ready Documentation

Accurate and timely documentation maintained for full audit readiness

Impact on Revenue Cycle & Patient Experience
Measurable Value Across Your Organization
01

Reduced Auth Denials

Fewer denials related to missing or invalid authorizations

02

Faster Reimbursement

Accelerated claims processing with pre-approved services

03

Fewer Delays

Minimized patient appointment delays or cancellations

04

Patient Confidence

Improved transparency and patient trust through proactive communication

Align Care Delivery With Payer Requirements

Prior Authorization under Patient Access Services ensures care delivery aligns with payer requirements while protecting revenue and enhancing the patient experience. Partner with UIGS Care for comprehensive authorization services.

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