Document Indexing
HEALTHCARE ADMINISTRATIVE SERVICES
PRECERTIFICATIONS & PRIOR AUTHORIZATIONS
Expert-managed insurance precertification and prior authorization services — from eligibility verification through final approval or appeal. Your team focuses on patients; we handle the payers.
24–48h
Follow-up Guarantee
100%
Pre-Visit Verification
HIPPA
COMPLIANT
THE CHALLENGE
Authorizations are complex. We make them seamless.
Insurance precertification and prior authorizations require skilled specialists to ensure all necessary processes are followed in accordance with plan requirements. Each request for additional information or precertification must be followed up to ensure approval before the service is provided.
ProviderSense provides a blend of dedicated staff and automation to handle your prior authorizations correctly and on time. We complete all benefits verification work before your patients' visit and follow up with payers until we have obtained confirmation of insurance authorization approval or denial.
Start to finish management
We track every authorization from initial submission through final approval or denial — nothing falls through the cracks.
Guaranteed 24–48h follow-up
We guarantee follow-up on every submission approval status within 24 to 48 hours, no exceptions.
Payer Expertise
Our specialists stay current with precertification processes for Medicare, Medicaid, and all major commercial payers.
STEP TWO
THE AUTHORIZATION PROCESS
Once eligibility is confirmed, our team manages the full authorization workflow — from opening the case to delivering the final authorization number to your billing system.
01
Determine Authorization Requirements
We identify which CPT codes require authorization for each patient and open a case with the payer's insurance authorization department.
02
Submit Clinical Documentation
We securely send all required supporting clinical documentation to the payer in the format they require, ensuring complete and compliant submissions.
03
Follow Up Until Resolution
We follow up with payers on every case, guaranteeing status updates within 24–48 hours. We do not let authorizations sit idle.
04
On Approval — Deliver Auth Number
After obtaining the authorization, we send you the authorization number and update the information in your billing system or our portal immediately.
05
On Denial — Manage Appeals
If denied, we gather additional records and supporting details from your office and submit them to the insurance company for further review.
06
Peer-to-Peer Review Coordination
If a payer requests a peer-to-peer review, we update your billing system and portal, and communicate all necessary details to schedule the provider's call with the payer.
THE BENEFITS
Advantages of Our Service
Outsourcing precertifications to ProviderSense creates measurable improvements to your billing outcomes, staff efficiency, and patient experience.
01
Expertise
Our precertification specialists stay current with all precertification processes for Medicare, Medicaid, and all other payers. Our expertise allows your staff to focus on other tasks without spending time on ongoing training or payer-specific rule changes.
02
Fewer Billing Issues
We provide the expertise and proper diligence necessary to track each medical prior authorization request from start to finish. This results in fewer incomplete precerts and fewer billing errors — with a guaranteed 24–48 hour follow-up on every submission status.
03
Improved Patient Satisfaction
We ensure patients have the necessary precerts before their appointment. This means less time spent tracking down forms or information, and fewer appointments rescheduled because a precert hasn't been processed.
03
Save Time & Money
Our services help you streamline day-to-day operations, saving time and reducing constant disruption. You also avoid the cost of hiring and training dedicated staff for tasks that can be handled more efficiently by our expert team and automation.
GET IN TOUCH
Let's Start a Conversation
We can schedule a brief intro call, a detailed discussion about your needs and our capabilities, or an on-site meeting. No commitment required.