Prior authorization is no longer a small administrative step. It is a critical revenue-protection function inside modern healthcare. Miss one approval, submit incomplete documentation, or overlook payer-specific authorization requirements, and the result is delayed care, denied claims, and lost revenue. Medhasty delivers expert Prior Authorization Services designed to protect reimbursement, support patient care, and keep revenue cycle management running smoothly.
Medhasty is a Maryland-based medical billing company serving healthcare practices across the United States, including high-regulation states such as New York, North Carolina, and New Mexico. Our team manages the entire prior authorization process with precision, compliance, and payer expertise, so providers can focus on care instead of chasing approvals.
Prior authorization is a process where an insurance company reviews a requested medical service before it is provided and determines whether it will be covered. Health insurance companies require prior approval to confirm medical necessity, control utilization, and manage costs across insurance plans.
When a prior authorization request is missing, late, or incorrectly submitted, insurance companies often deny the claim entirely. These claim denials occur even when the medical procedures were appropriate and delivered correctly. This makes prior authorization a core pre-service step in revenue cycle management, not just paperwork.
The prior authorization process typically occurs before outpatient services, imaging, behavioral health services, Durable Medical Equipment, prescription drug therapies, PET scans, and many specialty medical services. It connects clinical documentation, payer requirements, and billing workflows into a single approval pathway that directly affects reimbursement timelines.
Medhasty provides full-service medical prior authorization services that cover every step of the pre-service approval cycle.
We prepare and submit accurate prior authorization requests, validating them against CPT and ICD-10 codes. Our team works across payer-specific provider portals, including Medicare Advantage and commercial insurance platforms, to ensure compliance with authorization requirements.
We review clinical documentation to ensure it supports medical necessity. Clinical notes, care plans, medical records, and supporting evidence are aligned with payer guidelines before submission.
Authorization requests do not stop at submission. We proactively communicate with payers, track approval status in real time, and escalate delays when needed. This shortens turnaround times and avoids stalled requests.
When prior approval is denied, we review the denial and gather additional documentation, then submit appeals. Our authorization solutions focus on preventing denials and enabling recovery.
For urgent cases, outpatient services, and time-sensitive treatments, we prioritize follow-ups to minimize care delays and avoid emergency room complications or surprise bills.
Prior authorization sits at the front end of revenue cycle management, where financial risk is either controlled or created.
Insurance companies closely scrutinize high-cost medical procedures, specialty care plans, and prescription drug usage through Utilization Management programs.
Medical necessity validation is the foundation of insurance approvals. If clinical notes, medical records, or required information do not clearly support the service, authorization approval may be delayed or denied. These delays ripple through the claims process and often result in lost revenue.
Effective prior authorization services prevent claim denials before they occur, protect cash flow, and shorten reimbursement timelines.
When authorizations are handled correctly, healthcare providers experience fewer billing disruptions, better patient satisfaction, and improved financial predictability.
Many providers view prior authorization as an efficiency issue. Medhasty treats it as revenue continuity.
Our services reduce claim denials by ensuring approvals are secured before services are rendered.
Faster approvals lead to faster reimbursement cycles and healthier cash flow.
Our seamless handoff to billing teams ensures authorized services move smoothly into claims submission without breakdowns.
By eliminating pre-service risk, healthcare providers avoid lost claims, delayed payments, and unnecessary write-offs.
Even well-run medical practices struggle with prior authorization because payer rules constantly change, and staff resources are limited.
Delays from Incomplete Clinical Documentation: Missing clinical documentation, outdated medical records, or incomplete required information often slow approvals. Insurance companies may place requests on hold for multiple business days, delaying care and reimbursement.
Changing Payer Requirements: Each health plan has unique authorization requirements. Medicare Advantage plans, commercial insurance policies, and Pharmacy Benefit programs apply different rules, portals, and drug lists. Keeping up with these changes overwhelms internal teams.
Staff Overload & Administrative Burden: Doctors’ offices and billing teams face a growing administrative burden. Prior authorization requests require phone calls, provider portal submissions, follow-ups, and documentation uploads, all of which pull staff away from patient-facing tasks.
Staff Overload & Administrative Burden: Doctors’ offices and billing teams face a growing administrative burden. Prior authorization requests require phone calls, provider portal submissions, follow-ups, and documentation uploads, all of which pull staff away from patient-facing tasks.
At Medhasty, our prior authorization workflow is built around transparency, accuracy, and revenue protection. We treat prior authorization services as a core pre-service revenue cycle management function, not a clerical task. Every step is designed to meet payer requirements, secure faster approvals, and prevent claim denials before they ever reach the billing stage.
We begin with a detailed service and CPT review. Our authorization specialists carefully review the ordered medical procedures, CPT codes, and ICD-10 diagnoses to confirm that the service aligns with payer-specific authorization requirements. This early validation is critical, especially for high-cost outpatient services, behavioral health services, diagnostic imaging, and durable medical equipment. By validating codes upfront, we reduce rework and eliminate avoidable denials tied to incorrect or missing information.
Next comes documentation collection and review. We work closely with healthcare providers and office staff to gather clinical documentation, medical records, and supporting notes that demonstrate medical necessity. Insurance companies and health insurance plans demand clear justification, and incomplete documentation is one of the biggest causes of authorization delays. Our team ensures all required information, including treatment plans and prior approval criteria, is in place before submission.
Once documentation is complete, we move to authorization submission. Our team submits prior authorization requests via payer and provider portals, as well as direct communication channels used by major health insurance companies. Whether the request involves Medicare Advantage, commercial insurance plans, or managed Medicaid, we follow the correct prior authorization process for each insurance company to avoid unnecessary delays.
After submission, payer follow-ups and status tracking become our responsibility. We actively monitor authorization requests, track turnaround times measured in business days, and follow up with insurance companies before deadlines expire. Instead of waiting passively, our specialists escalate requests when needed, respond to additional documentation requests, and keep your practice informed of real-time status updates.
Once authorization is approved, we proceed to confirmation and documentation. Approved authorizations are verified against the original request, logged accurately, and stored securely in HIPAA-compliant systems. This step protects patient care continuity and ensures there are no surprises during claim submission.
Finally, we handle coordination with the billing team. Approved authorizations are seamlessly handed off to your billing services or internal billing team, ensuring clean claims submission, fewer claim denials, and improved cash flow. This alignment between authorization and billing ensures approvals lead to timely reimbursement rather than lost revenue.
Our specialists understand insurance policies, payer rules, and Utilization Management standards across health insurance companies, including Cigna Healthcare and other major payers.
All prior authorization services are fully HIPAA-compliant. We protect PHI through secure systems, controlled access, and strict data security protocols.
Medhasty’s RCM leadership is Maryland-based, providing oversight, accountability, and consistent quality as it serves healthcare practices nationwide.
Choosing the right partner for prior authorization services can make the difference between steady cash flow and constant claim denials. Medhasty stands apart by combining compliance, expertise, and a revenue-first mindset.
We are a Maryland-based medical billing company with deep experience serving healthcare providers across the United States. Our location signals trust and accountability, while our nationwide reach ensures we understand payer rules in states like New York, North Carolina, New Mexico, and beyond. We work with diverse insurance companies and health insurance plans every day.
Our RCM-first approach means prior authorization is never treated as an isolated task. We align authorization activities with your broader revenue cycle management strategy, connecting approvals directly to clean claims, faster reimbursements, and long-term revenue protection.
Medhasty provides dedicated authorization specialists who focus exclusively on prior authorization requests, payer communication, and denial prevention. These specialists understand utilization management, medical necessity standards, and payer documentation rules, allowing them to resolve issues quickly and accurately.
With nationwide coverage across the USA, we support medical practices, healthcare professionals, and multi-specialty groups regardless of location. Our HIPAA-compliant workflows protect patient information while ensuring consistent service delivery across time zones and payer networks.
Most importantly, our clients experience faster approvals and fewer denials. By submitting accurate requests, proactively tracking authorizations, and coordinating closely with billing teams, we help protect revenue, shorten reimbursement timelines, and improve patient satisfaction. At Medhasty, prior authorization services are not just about approval—they are about safeguarding your practice’s financial health.
Medhasty supports a wide range of healthcare providers and medical practices. Our prior authorization services are commonly used in:
Primary care
Behavioral health services
Podiatry
Cardiology, and multi-specialty practices
Each specialty faces unique authorization requirements, and our workflows adapt accordingly.
Prior authorization should never be the reason revenue is lost or care is delayed. Medhasty’s Prior Authorization Services help healthcare providers secure faster approvals, prevent denials, and protect cash flow.
Let Medhasty manage authorizations with precision, compliance, and confidence, so your practice can focus on delivering quality healthcare.
FAQS
A complete prior authorization service covers the entire pre-service approval cycle for healthcare providers. This includes reviewing CPT and ICD-10 codes, preparing and submitting prior authorization requests, and validating medical necessity using clinical documentation and medical records. The process also involves ongoing payer follow-ups with insurance companies, tracking authorization approval status, and addressing authorization requirements tied to specific health insurance plans. Coordination with billing services ensures approved authorizations move smoothly into the claims process. The goal is to prevent denial and improve revenue cycle management.
Prior authorization timelines vary by insurance company, health plan, and type of medical service requested. Many standard requests are processed within a few business days, while complex medical procedures, behavioral health services, or durable medical equipment may take longer. Medicare Advantage and commercial insurance plans often have different utilization management timelines. Proactive follow-ups and the completion of required information help reduce delays. Consistent tracking supports faster reimbursement timelines and uninterrupted patient care.
Prior authorization is commonly required for high-cost or high-risk medical procedures. This often includes diagnostic imaging such as PET scans, outpatient services, behavioral health services, and durable medical equipment. Specific prescription drug therapies and pharmacy benefit requests also require prior approval. Requirements vary across insurance policies and health insurance companies. Verifying authorization needs before services are delivered helps prevent claim denials and surprise bills.
Authorization denial management is part of a comprehensive prior authorization process. This includes reviewing denial reasons, gathering additional clinical documentation, and submitting appeals that address payer-specific medical necessity criteria. Ongoing communication with insurance companies and utilization management teams supports reconsideration and approval. Successful appeals protect cash flow and reduce lost revenue. Detailed tracking ensures denied requests do not fall through the cracks.
All prior authorization workflows follow HIPAA-compliant standards designed to safeguard protected health information. Secure systems, controlled access, and documented processes are used when handling medical records, clinical documentation, and patient data. Compliance is maintained across payer portals, provider portals, and internal communication channels. This approach protects patient care and supports regulatory compliance. Data security remains a priority throughout the authorization process.
The cost of prior authorization services depends on request volume, payer complexity, and the range of medical services involved. Practices managing multiple insurance plans or high volumes of outpatient services may require more extensive support. Transparent pricing models help healthcare providers control operational costs without hidden fees. A Free Consultation allows practices to review needs and receive tailored authorization solutions. This ensures cost-effective support aligned with revenue cycle goals.
Let our medical billing experts optimize your revenue cycle management. We enable healthcare practices to increase cash flow and avoid denials. Permanently!
