Prior Authorization Services
Your Nurses Should Be With Patients. Not on Hold with Payers.
Prior auth pulls clinical staff into phone queues and payer portals, and payers don't reimburse unauthorized services. Our specialists obtain, track, and manage prior authorizations, supported by technology that keeps approvals moving and your denials down.
Two Business Days a Week, Just for Permission Slips
Prior authorization quietly drains nearly two business days of physician and staff time every week, and every missed approval turns into a denied claim on care you already delivered.
Nearly Two Business Days a Week
Physicians and their staff spend an average of 13 hours per week on prior authorizations, roughly 39 requests per physician (2024 AMA Prior Authorization Physician Survey). Two in five physicians have staff who work on nothing else.
Growing Payer Requirements
Nearly every commercial payer requires prior authorization for certain services, and the lists grow every year. Miss one and the claim is denied outright, with no appeal and no rework.
Failures Become Permanent
When an authorization falls through the cracks, that is lost revenue on a service you already provided. With over 50% of denials never refiled, most authorization failures become permanent losses.
Specialists Who Own the Auth, Technology That Does the Legwork
Named prior-auth specialists own every authorization: they read each payer's clinical criteria, build the submission package, and handle the exceptions, peer-to-peer reviews, and appeals that a payer throws at a high-value request. Technology does the legwork around them: it submits and monitors authorization requests, adapts to each payer's rules in real time, and flags the requests that have stalled or come back needing more information. That keeps our specialists focused on the clinical judgment and the payer conversations, while your nurses stay with patients instead of on hold.
Full-Service Authorization Management
We handle the entire prior auth lifecycle, from identifying which services need authorization to obtaining approval and confirming it before the service is scheduled. Your team is notified when it's approved. That's their only touchpoint.
Clinical Documentation Support
We know what clinical documentation each payer requires for each service category. We prepare the submission package so your clinical staff only needs to review and sign, not research and compile.
Status Tracking and Payer Follow-Up
Every authorization is tracked from submission to decision. Our team follows up on pending requests daily and responds to payer information requests the same day. We don't wait for callbacks, and we don't let requests sit in queue.
High-Value Claim Protection
We prioritize authorization by claim value and complexity. Your highest-revenue services (surgeries, advanced imaging, specialty drugs) get the most thorough attention and the earliest submission. If authorization is denied, we appeal immediately.
13 hrs/wk
Physician and Staff Prior Auth Burden
The 2024 AMA survey reports physicians and their staff spend 13 hours per week on prior authorizations. KeyMed Partners takes that workload off your team.
40%
Have Staff Working Solely on Prior Auth
Two in five physicians employ staff who do nothing but prior authorization (2024 AMA survey). That is payroll spent obtaining permission to provide care.
50%
Denial Reduction Across the Cycle
Measured against your baseline and reviewed quarterly, with some of the largest gains coming from authorizations obtained and confirmed before the service is scheduled.
Prior Authorization FAQs
Who actually obtains the authorization, your team or software?
Named prior-auth specialists own each authorization. They read the payer's clinical criteria, assemble the submission package, and handle the peer-to-peer reviews, exceptions, and appeals. Technology does the legwork around them: it submits and monitors requests, adapts to each payer's rules in real time, and flags anything that has stalled or come back needing more information. The technology surfaces the work and keeps it moving; people make the clinical and payer judgment calls.
What does my clinical staff actually have to do?
As little as possible. We identify which services need authorization, prepare the submission package so your clinicians only review and sign rather than research and compile, and follow up with payers until there's a decision. In most cases your team's only touchpoint is a notification that the authorization is approved before the service is scheduled.
How do you keep authorizations from falling through the cracks?
Every request is tracked from submission to decision, and the technology flags pending or stalled authorizations so a specialist follows up the same day rather than waiting on a callback. Authorizations are prioritized by claim value and turnaround window, so your highest-revenue services (surgeries, advanced imaging, specialty drugs) get the earliest submission and the most thorough attention.
What happens if an authorization is denied?
A specialist appeals it. They pull the payer's stated reason, address the clinical gap, and resubmit, escalating to a peer-to-peer review when that's what the payer requires. Because an unauthorized service won't be reimbursed and most denials are never refiled, working the appeal promptly is what protects revenue on care you've already delivered.