Prior Authorization Services
Prior authorization is one of those jobs that never quite fits anyone's day. Clinical notes have to be gathered, each payer wants something slightly different, and approvals expire while everyone is busy with patients. When it slips, the service gets delayed or the claim is denied after the fact.
Our prior authorization team takes the whole job off your staff. We collect the documentation, submit the request, follow up with the payer, and track every approval through to the date of service and beyond. Our eligibility and authorization work runs at a 99.9% accuracy rate.
What we handle
- Checking whether a planned service, procedure, test or item needs authorization for that payer and plan
- Gathering and organizing the clinical documentation each payer asks for: orders, notes, diagnoses and supporting records
- Submitting requests through payer portals, electronic channels or direct contact, whichever the payer requires
- Following up on pending requests until each one is approved, denied or needs more information
- Recording authorization numbers, approved dates, units, codes, site of service and rendering provider
- Re-authorization for ongoing care, started ahead of expiration so there are no gaps
- Authorization and eligibility coordination for recurring services such as therapy, infusion, home health and DME resupply
- Escalating requests that are still pending close to the date of service
Our team supports multi-specialty practices, laboratories, behavioral health, home health, infusion centers and DME suppliers, among the 15+ specialties we serve. DME is one example. The same discipline applies wherever approval comes before payment.
How our prior authorization process works
- Confirm the requirement. After eligibility is verified, we check whether the planned service needs authorization under that patient's plan, and which payer rules apply.
- Build a complete packet. We collect the clinical documentation and flag anything missing back to your team early, instead of submitting a request that is likely to pend.
- Submit and track. The request goes to the payer through the channel it requires, and we log it so every open request has an owner and a status.
- Follow up until there is an answer. We check on pending requests, respond to payer questions and escalate anything close to the date of service.
- Match the approval to the claim, and watch for expiry. We record the approved details so the claim matches what was authorized, and track end dates and remaining units so re-authorization starts on time.
Why practices choose Salyx
- Accuracy that protects the claim. A 99.9% accuracy rate in eligibility and authorizations, supported by documented processes under our ISO 9001 certification.
- Nothing gets lost. Every request is tracked, and approvals are monitored for expiration so recurring care stays covered.
- Fast and paperless. 100% paperless processing and 65% faster processing.
- Secure by design. HIPAA-compliant processes, ISO 27001-certified information security, and MFA/VPN access, encryption and locked devices.
- Built into the revenue cycle. Authorization sits next to eligibility and claim submission, so what was approved is what gets billed. For the thinking behind this, read our guide on prior authorization delays and the front-end fix.
Frequently asked questions
Which services usually need prior authorization?
It depends on the payer and the plan. Certain procedures and tests, infused drugs, therapy visits, home health, and many DME items and supplies commonly require it. We check requirements for each patient and payer instead of relying on a general list.
What do you need from our team?
The order or referral, the relevant clinical notes and the patient's insurance details. If something is missing, we tell you what and why, so the request doesn't sit pending.
Can you handle re-authorizations for ongoing care?
Yes. We track end dates and remaining units, and start re-authorization ahead of expiration so recurring care and resupply are not billed after approval lapses.
What if a request is denied?
We review the denial reason, add or correct documentation where we can, and resubmit or appeal as the payer allows. We also look at why it happened, so the same gap is closed at the front end.
Do you work in our existing systems?
Yes. We work with major EHR, EMR and practice management platforms and follow your scheduling and documentation workflow.
How is patient information protected?
We work under HIPAA, protect data with MFA/VPN access, encryption, background checks and NDAs, and do not accept PHI through website forms. We'll give you an approved secure method for sharing documents.
See where authorizations are costing you
We'll look at your authorization and eligibility steps and recent denials, and show you where approvals are slipping. No cost, no obligation.
Get a Free Billing Audit Contact Us
info@salyxrcm.com | (321) 788-3655