Prior Authorization Services
Turn your prior authorization headache into your competitive edge
We’ve spent 13 years perfecting the art of getting to “yes” when insurers want to say “no.” Our expert-driven prior authorization services reduce processing time by 68% while keeping your revenue flowing.Â
Prior Authorization: The Paper Cut That Causes Financial HemorrhageÂ
Every healthcare practice has that one administrative burden that quietly drains profitability. For most, it’s prior authorizations—the seemingly innocuous process that somehow consumes 13 hours per physician per week.
That’s not just paperwork; it’s a silent profit thief. While your highly-trained staff members are on hold with insurance companies, they’re not doing the revenue-generating work you hired them for. It’s like using a Ferrari to deliver groceries.
What if this administrative quicksand could become solid ground for competitive advantage?Â
Understanding Prior Authorizations: Prescriptions vs. ProceduresÂ
Prior authorizations generally fall into two distinct categories, each with unique challenges:
Prescription Authorizations:
Procedure Authorizations:
- Often processed through electronic systems with standardized criteria
- Typically faster turnaround (hours to days)
- May be automated through e-prescribing platforms
- Usually initiated at the pharmacy level
- Common for specialty medications, controlled substances, and non-formulary drugsÂ
- Primarily manual review processes requiring clinical documentation
- Longer turnaround times (days to weeks)
- Require substantial clinical justification and documentation
- Complex coding requirements with specialty-specific nuances
- Critical for imaging, surgeries, specialty treatments, and durable medical equipmentÂ
While prescription authorizations have benefited from automation advancements, procedure authorizations remain largely manual, labor-intensive processes that create significant administrative burden. Our service specializes in navigating both worlds, with particular expertise in the complex landscape of procedure authorizations.
Bridging the Automation Gap in Prior Authorizations
While prescription prior authorizations have increasingly moved toward automation, procedure authorizations remain stubbornly manual. This disparity creates unique challenges for practices:Â
The Automation Reality:Â
- Prescription authorizations: Often processed through electronic systems with standardized criteria and automated approval pathways
- Procedure authorizations: Still largely manual, requiring significant human expertise and follow-upÂ
Our service excels in both environments by:Â
- Maximizing available automation: Utilizing electronic submission methods whenever available
- Human expertise where it counts: Deploying specialists for the manual aspects that require clinical judgment and payer-specific knowledge
- Process standardization: Implementing consistent workflows that minimize variation and errors
- Follow-up protocols: Establishing systematic approaches to pending authorizations that prevent delays
- Continuous improvement: Tracking authorization outcomes to refine our approach with each submissionÂ
This hybrid approach allows us to achieve efficiency without sacrificing the human expertise needed for complex authorizations. The result is faster approvals with fewer denials across both prescription and procedure authorizations.Â
Prior Authorization Services Process: Step-by-Step
Understanding the complete workflow reveals why this process is so prone to bottlenecks:Â
- Verification: Determining if a service requires prior authorization (varies by payer)Â
- Data Collection: Gathering clinical documentation, patient information, and insurance details
- Form Completion: Filling out payer-specific forms with precise coding and justifications
- Submission: Transmitting the request through the correct channels (portal, fax, phone)
- Follow-up: Tracking requests, responding to additional information requests, and appealing denials
- Documentation: Recording approvals and maintaining audit-ready recordsÂ
Each step presents opportunities for errors or delays. When your staff juggles dozens of requests across multiple payers—each with their own requirements—it’s no wonder that things fall through the cracks.
13 Years of Authorization Mastery: We've Seen Every Trick in the Book
Since 2011, we’ve been decoding the unwritten rules of insurance companies, turning prior authorization from art to science. What took us years of hard-earned wisdom can now benefit your practice immediately.Â
Our approach leverages:Â
- Payer-Specific Intelligence: We’ve mapped the approval tendencies of every major insurer
- Specialist Authorization Teams: Our experts focus on specific specialties and payersÂ
- Refined Workflows: Proven processes that eliminate common bottlenecks
- Documentation Strategy: We know exactly which clinical details trigger approvalsÂ
- Strategic Follow-Up Protocols: Our systematic approach transforms “pending” to “approved”Â
This experience enables us to navigate complexities that leave in-house teams spinning their wheels.Â
The Neolytix Advantage
The Team Your Practice Has Been MissingÂ
At Neolytix, we’ve spent 13 years refining our approach to prior authorizations, creating a system that delivers remarkable results.Â
Our team doesn’t just process authorizations—we transform your entire approach:Â
- Industry-leading specialists who understand clinical requirements and payer nuances
- Payer-specific strategies based on our database of approval patterns
- Clinical documentation enhancement that addresses common denial reasonsÂ
- Real-time visibility through intuitive dashboards that track every request
- Right-shore operational model combining US-based specialists with global teams for 24/7 processingÂ
The difference is measurable: practices working with Neolytix typically see a 68% reduction in processing time and a 23% increase in approval rates within the first 90 days.Â
Meet Our Prior Authorization TeamÂ
What sets Neolytix service apart is our people. Our prior authorization team includes:
- Certified medical coders who ensure precise procedure and diagnosis coding
- Former insurance reviewers who understand approval criteria from the insideÂ
- Specialty-specific experts who speak the clinical language of your practice
- Appeals specialists trained to overturn initially denied authorizations
- Dedicated account managers who become extensions of your teamÂ
This human expertise—refined over 13 years serving healthcare organizations of all sizes—means we understand not just the technical aspects of prior authorization, but the real-world challenges your practice faces.Â
The Prior Authorization Self-Test: Are You Leaving Money on the Table?Â
Ask yourself these questions:Â
- Are prior authorization denials affecting your revenue cycle?
- Is your clinical staff spending hours on paperwork instead of patient care?
- Do you struggle to keep up with constantly changing payer requirements?
- Are patients experiencing care delays due to authorization bottlenecks?Â
If you answered “yes” to any of these questions, outsourcing prior authorization could be transformative for your practice.Â
With Neolytix's prior authorization services, you gain:Â
- Cost savings: Reduce administrative expenses by up to 40%Â
- Revenue acceleration: Get paid faster with fewer denialsÂ
- Scalability: Handle volume fluctuations without staffing challenges
- Risk mitigation: Stay compliant with ever-changing regulations
- Patient satisfaction: Eliminate unnecessary care delaysÂ
Our flexible engagement models allow you to outsource your entire prior authorization process or just the aspects that cause the most friction.Â
Frequently Asked Questions About Prior Authorization
Prescription authorizations typically involve medications and are often processed through electronic systems with standardized criteria, resulting in faster turnarounds. Procedure authorizations cover services and treatments, require manual review with extensive clinical documentation, have longer processing times, and remain largely non-automated despite technological advances. Â
Prior authorizations for prescriptions help insurance companies control costs by ensuring expensive medications are only prescribed when medically necessary and after more affordable alternatives have been tried.Â
Insurance authorization should be obtained whenever a payer requires pre-approval for a service, procedure, equipment, or medication. This typically includes most surgeries, advanced imaging, specialty medications, and certain therapies.Â
Yes, most hospitals must obtain prior authorization for non-emergency inpatient admissions, certain outpatient procedures, and high-cost diagnostic testing. Failure to secure proper authorization can result in significant claim denials.Â
Insurance companies employ nurses, physicians, and other clinical reviewers to evaluate prior authorization requests against established clinical guidelines and policy criteria.Â
may be processed within 24-72 hours. With Neolytix’s streamlined processes and dedicated follow-up protocols, many authorizations can be processed more quickly than industry averages.Â
Without required prior authorization, insurance companies typically deny claims, leaving either the provider or patient responsible for the full cost of services. Some contracts prohibit balance billing patients in these situations, putting the financial burden entirely on providers.Â
While most practices don’t charge patients directly for prior authorization services, the administrative costs are built into overall healthcare pricing. Some concierge practices may include authorization processing in their membership fees.Â
Don't Let Prior Authorizations Hold Your Practice BackÂ
Every minute your team spends on administrative tasks is a minute they’re not spending on patient care or revenue-generating activities.Â
Neolytix’s prior authorization services combine 13 years of healthcare expertise with proven processes to transform this necessary burden into a streamlined operation.Â
Our clients report:Â
- 68% faster processing times
- 23% higher approval rates Â
- 40% reduction in administrative costsÂ
- Happier staff and more satisfied patientsÂ
Ready to see what Neolytix can do for your practice?Â
