Prior Authorization / Pre-Certification Management Services

Our 360-degree Prior Authorization/Pre-Cert Approach

OUR APPROACH

Our 360-Degree Prior Authorization/Pre-Cert Solution

Prime Care Health Solutions' secure, HIPAA-compliant Prior authorization and precertification management service simplifies the entire prior authorization (PA) pre-certification process, saving physicians, pharmacists, and other healthcare providers' valuable time, and ensuring patients receive their medication and equipment faster.

1
Easy Integration

Start by entering patient information, diagnosis, and fee codes into our online PA/Pre-Cert authorization request form. No major process shifts needed since your intake staff already collects all the pertinent information for each patient.

2
Expert Management

One of our knowledgeable staff members takes over managing the process from start to finish. If additional information or physician contact is needed, we keep you informed to keep the process moving forward.

3
Seamless Process

Once approval is acquired, we complete all action items and handle required data entry. If the request isn't approved, we handle the follow-up and appeals on your behalf.

Work with us
Healthcare professional working on prior authorization

Our Pre-Certification Process

A streamlined workflow designed for your practice's efficiency

1

Submit Request

Start by entering patient information, diagnosis, and fee codes into our online PA/Pre-Cert authorization request form. Your intake staff already collects this data daily—no major process changes needed.

2

We Manage It

One of our knowledgeable staff members takes over managing the process from start to finish. If your insurance provider needs additional information or physician contact, we keep you informed.

3

Completion

Once approval is acquired, we complete any action items and handle required data entry. If the request isn't approved, we handle the follow-up and appeals.

What We Do

Comprehensive prior authorization management services

Gathering of vital information

Complete collection of all necessary patient and clinical data

Check patient eligibility

Verify insurance coverage and patient eligibility status

Communicate with payers

Validate prior authorization requests with insurance payers

Follow up on authorization status

Regular payer communication to track authorization progress

Manage physician requests

Follow up with ordering physicians for additional documents

Submit additional information

Provide payer-requested documentation and supporting materials

Outcome updates

Keep you informed regarding authorization outcomes and status

Dedicated account manager

Affordable hourly rate or pay-per-PA/Pre-cert case with personalized support

Why Choose Our Service

Proven advantages for your practice

Network Knowledge

We apply network-based knowledge about prior authorizations to your practice in real time

Zero Errors

Reduce duplication and data errors through our streamlined processes and quality controls

Maximize Reimbursements

Our specialists submit documentation and work with payers to obtain authorizations and maximize claim reimbursements

Exceptional Success Rate

We have an exceptional success rate obtaining authorizations, with most delivered with zero client work

Fast Turnaround

Almost all authorizations are started and completed within one week with our dedicated team

System Integration

Our team combines with all leading practice management systems for streamlined prior authorization assistance

Our Process, Simplified

Everything you need to know about our PA/Pre-Cert Management

Patient Eligibility Verification

Customized verification process

HIPAA-compliant insurance verification and authorization solutions

Complete prior authorization processing, from initiation to approval

Physician consultation and appeals when needed

Additional Support

Regular PA-Pre-Cert status updates

Dedicated PA-Pre-Certification team keeps up with training and compliance

No requests fall through the cracks with streamlined billing

STAT service, no long-term contracts, flexible options

Affordability & Speed

Extremely affordable with fast turnaround time

Work as an extension to your practice

Experts in almost all specialties

Avoid Common Issues

Avoid patient care delays, claim denials and appeals

Accurate verification of co-pays, deductibles, and payable benefits

Ensure billing compliance with constant monitoring