How far ahead do you verify?

Far enough ahead that a problem can still be fixed, which in practice means working from your schedule rather than from the day sheet.

Do you handle the peer-to-peer when an authorization is denied?

We handle the submission, documentation and follow-up. A peer-to-peer review is a clinical conversation and has to be your provider, but we set it up and track the outcome.

What if a service was performed without authorization?

Some payers allow retro-authorization within a window and some do not. We will tell you which situation you are in rather than submitting and hoping.

Service

Eligibility and prior authorization

Most coverage denials are decided before the patient is seen. Verifying eligibility after the visit tells you what you already lost; verifying it beforehand is what prevents the loss.

Verified before the visit

Active coverage, plan type, deductible and out-of-pocket status, and whether your provider is in network for that specific plan are checked ahead of the appointment. Being in network with a payer is not the same as being in network with every one of that payer's plans, and that distinction produces a lot of avoidable denials.

Authorizations tracked to a decision

Prior authorization requests are submitted with the clinical documentation the payer asks for, then followed until there is an actual decision rather than left in a queue. Approval numbers, unit counts and expiry dates are recorded so the claim can reference them and so nobody schedules past an expired authorization.

The front desk finds out first

Coverage problems are flagged before the appointment, while there is still time to reschedule, collect, or get an authorization started. That is a better conversation for your staff to have with a patient than one about a bill nobody expected.

What is included

Benefit and deductible checks
Prior auth submission and follow-up
Coverage alerts before the appointment

Common questions

How far ahead do you verify?: Far enough ahead that a problem can still be fixed, which in practice means working from your schedule rather than from the day sheet.
Do you handle the peer-to-peer when an authorization is denied?: We handle the submission, documentation and follow-up. A peer-to-peer review is a clinical conversation and has to be your provider, but we set it up and track the outcome.
What if a service was performed without authorization?: Some payers allow retro-authorization within a window and some do not. We will tell you which situation you are in rather than submitting and hoping.

Other services

Back to all services

Next step

Start with the free A/R review.

Send an aging summary and a handful of denials. You get a written read on what is recoverable — no fee, no obligation to sign anything.

Book the A/R review See pricing