Prior authorization is the process of obtaining a payer's approval before a service is rendered. It exists as a distinct step because payers treat it as a separate gate from medical necessity. Without that approval on file, the claim will be denied no matter how well documented or medically necessary the service was: the payer never agreed to cover it in the first place. Billed Right submits authorization requests within 12 to 24 hours, tracks every step of the approval process, and notifies the practice immediately if a peer-to-peer review is requested, so no authorized service goes unrendered and no rendered service goes unauthorized.
The Real Cost of Authorization Gaps
Prior authorization is the single most administratively burdensome process in medical billing. Every request means hold times with payer call centers, portal submissions that vary by plan, and back-and-forth on clinical documentation: work that pulls both clinical and administrative staff away from patient care and into a process that produces nothing until it's approved. For a practice handling authorizations without a dedicated workflow, that burden doesn't stay contained to the billing office. It lands on the same staff who are also trying to run the front desk and support the clinical team.
The cost of getting it wrong is worse than the time it takes to get it right. A missed authorization doesn't produce a denial that can be appealed on medical necessity grounds. It produces an automatic denial for a service the payer never agreed to cover, and that determination is often unappealable no matter how clean the documentation is. The service has already been rendered, the cost has already been incurred, and there's no path back to that revenue.
How Billed Right Handles Authorizations
- Authorization requests submitted to payers within 12-24 hours of receipt
- Referral requests managed alongside prior authorizations through the same workflow
- Detailed tracking of every authorization and referral: status, approval date, expiration, and units approved
- Immediate notification to the practice if a peer-to-peer review is requested by the payer
- All authorization work conducted within the practice's existing practice management system
- Close communication with clinical and administrative staff on approvals, denials, and appeals
Billed Right has provided prior authorization and referral management services since 2006, serving practices across the US from our base in Longwood, Florida.
Our Services
Schedule a Conversation
Top 5 Authorization Problems We Solve
Authorization Not Obtained Before Service
The claim submits without required auth and denies automatically on receipt.
Auth Expiration Not Tracked
Authorization was obtained but expires before the service date, resulting in a preventable denial.
Staff Time Consumed by Hold Times and Portals
Clinical staff get pulled from patient care to manage phone-and-portal auth workflows.
Peer-to-Peer Review Missed
The payer requests a physician review but the notification is missed, resulting in denial without appeal.
Units Exceeded
Service is rendered beyond the approved units without reauthorization, triggering partial or full denial.
What to Expect
Intake
Auth requests are identified from the schedule and submitted to payers within 12-24 hours.
Tracking
Every authorization is tracked through approval, denial, or pending status with expiration dates monitored.
Notification
The practice is notified immediately of approvals, denials, and peer-to-peer review requests.
Reauthorization
Expiring authorizations are flagged and resubmitted before the approved period ends.
Reporting
Monthly authorization approval rate, turnaround time, and denial report by payer and service type.
Frequently Asked Questions
Imaging, surgical procedures, certain injectable medications, durable medical equipment, and specialist referrals are among the services most commonly requiring prior authorization, though exact requirements vary by payer and plan.
We submit authorization requests to payers within 12 to 24 hours of receiving them, so approval turnaround starts as early as possible relative to the scheduled service date.
We notify the practice immediately so the reviewing physician can be scheduled for the call before the payer's response window closes, rather than the request sitting unanswered until it's too late.
Every authorization is logged with its approval date, expiration date, and approved units, and we flag it for reauthorization before it expires so the service date never falls outside an active approval.
Yes. Referral requests are managed alongside prior authorizations through the same workflow, so a service that requires both isn't split across two disconnected processes.
A prior authorization denial happens before the service is rendered and can often still be appealed or resubmitted. A claim denial for missing authorization happens after the service is already rendered, and is typically unappealable because the payer never approved the service in the first place.
More on prior authorization.
Prior Authorization Is Breaking Medical Practices: Here Is What You Can Do About It
A closer look at why prior authorization has become the most burdensome process in medical billing, and what practices can do to get ahead of it.
ReadClaim Denial Impact Calculator
Estimate how much revenue authorization-related denials are costing your practice each month.
Get itHow Outsourcing Prior Authorization Reduced Admin Burden and Eliminated Auth-Related Denials for a Specialty Practice
A composite look at how a specialty practice offloaded its authorization workflow and stopped losing revenue to missed approvals.
ReadReady to Take Prior Authorization Off Your Team's Plate?
Schedule a conversation with our authorizations team. We will review your current authorization process, identify where approvals are getting missed or delayed, and show you what we would do differently.