Requirement identification, document collection, payer-portal and phone follow-up, and status and expiration tracking - with escalation back to your team on every case.
Prior authorization is one of the most time-consuming administrative burdens an independent practice carries - hold queues, fax confirmations, portal logins, and a status board that lives in someone's head. This service takes on the administrative workload: identifying which services require authorization under the patient's plan, collecting the supporting documentation your practice specifies, submitting and following up through payer portals and phone lines, and tracking status and expiration dates so requests don't stall or lapse unnoticed.
Payers make authorization decisions, and clinical decisions remain with licensed providers. We do not approve, deny, or influence a payer's medical-necessity determination. That boundary isn't a footnote here - it shapes every part of how this service is scoped and delivered, because no administrative service, VMA included, can promise an outcome that belongs entirely to the payer.
What we can control is everything that happens before a payer makes that decision: whether the request was submitted complete and on time, whether the payer's follow-up cadence was actually followed instead of forgotten in a queue, and whether your team learned about a stuck or denied request in days rather than weeks. Most of the frustration practices describe with prior authorization isn't about the decision itself - it's about the administrative grind of getting a complete request in front of the payer and then chasing a response. That grind is exactly what this service is built to absorb.
| Included | Not included |
|---|---|
| Identifying whether a service requires prior authorization | Determining medical necessity or clinical appropriateness |
| Collecting documentation from your practice's approved sources | Writing or altering clinical documentation to support a request |
| Submitting the request via payer portal, phone, or fax | Approving or denying authorizations - payers make that decision |
| Following up with payers until a decision is issued | Guaranteeing approval or a specific turnaround time |
| Tracking status (submitted, pending, approved, denied) | Any clinical decision, of any kind |
| Tracking expiration dates & flagging renewals | Claims submission, coding, or billing tied to the service |
Prior authorization work rewards consistency more than almost any other front-desk task - a request that sits for a week because no one followed up is the most common way authorizations stall. Practices that succeed at this internally usually have one person who's simply very good at staying on it; practices that struggle often don't have that person to spare.
A VMA checks the patient's plan against the scheduled service to determine whether prior authorization is required.
Required documentation is gathered from your practice's approved systems, with chart access limited to what the submission requires.
The request is submitted through the payer's portal, fax, or phone line, following your practice's approved process.
Status is checked and logged until the payer issues a decision, following up on the payer's typical timeline.
Approved authorizations are tracked for expiration, and denials or missing documentation are escalated to your team immediately.
Payers make the decision at the center of this process - everything on our side is administrative work around that decision.
Checked against the patient's plan and the scheduled service.
Documentation gathered and filed through the payer's channel.
Status logged and followed up on the payer's typical timeline.
Denials, missing documents, or expirations reach your team fast.
Payers make authorization decisions, and clinical decisions remain with licensed providers - at every stage of this workflow. Nothing in this diagram implies otherwise; it's a map of administrative effort, not a promise of an outcome.
Authorization volume and complexity vary by specialty. These patterns are common across the practice types we currently support - not a guarantee of your practice's specific volume or outcome.
Imaging, procedures, and specialty medications frequently carry authorization requirements, often with detailed documentation expectations from the payer.
Certain medications and levels of care require authorization and renewal tracking, especially for ongoing treatment plans.
Referral-adjacent and diagnostic-imaging authorizations are common enough in general practice to justify a dedicated, documented tracking process.
These are the categories of requests a documented tracking workflow typically handles - not a promise of approval or a specific turnaround time.
| Scenario | What we do | What stays with your practice/provider |
|---|---|---|
| New request identified | Check the plan's stated requirement for the specific service | Confirm the service is being scheduled as planned |
| Documentation needed | Collect what the payer's submission requires from approved sources | Supply or approve the clinical documentation content |
| Request pending past typical timeline | Follow up with the payer and log each contact attempt | Decide whether to proceed, delay, or explore alternatives with the patient |
| Request denied | Log the denial and the payer's stated reason, escalate to your team | Determine the clinical basis for an appeal, if pursued |
| Authorization nearing expiration | Flag the upcoming lapse with enough lead time to renew | Decide whether the service is still needed and authorize renewal |
Prior authorization rarely lives in one system - it usually spans a scheduling entry, a chart note, a payer portal, and sometimes a fax confirmation. This service is designed to work across that spread rather than forcing it into a single new tool.
Prior authorization work touches more systems than almost any other front-desk task - the EHR for documentation, the payer portal for submission, sometimes a fax line or phone queue for older payer processes. Staff can be trained to support client-approved administrative workflows in commonly used EHR, practice-management, and payer-portal systems, with access scoped to only what a given submission requires. System-specific support depends on your credentials, training, and security requirements.
Where your practice's process still runs through fax or phone for certain payers, that channel is used exactly as it is today - we work inside your existing process rather than asking you to change payers or systems to fit ours. Access to payer portals, fax systems, and your EHR is limited according to client-approved roles and permissions, and a Business Associate Agreement may be executed when applicable.
Chart access for a given authorization request is scoped to what that specific submission requires, not blanket access to the full record. That's a deliberate design choice: it keeps the administrative work focused on the documents a payer actually asks for, and it keeps your practice in control of what's shared and with whom, consistent with your own access and security policies.
Common integration points:
Onboarding time depends on scope, access, training, and workflow complexity - this is a common pattern, not a fixed timeline.
The complimentary workflow assessment defines your current authorization volume, payer mix, and documentation sources.
Client-approved access is granted to payer portals, fax lines, and EHR fields, scoped to submission needs only.
Requests are identified, submitted, and tracked on your live schedule, with close review of the escalation path for denials and missing documents.
Requests initiated, pending, and escalated are reviewed on the cadence your practice sets, refining the process as payer patterns emerge.
The early weeks usually surface which payers in your mix require the most hands-on follow-up and which documentation requests recur most often for your specialty. That pattern recognition - which is hard to build when authorization work is spread across whoever has a free moment - is one of the quieter benefits of a dedicated, tracked workflow settling in.
Staff time shifts away from repetitive portal and hold-queue work toward patients in the office. Authorization status is visible and documented instead of tracked informally or not at all. Expiration dates are tracked proactively, reducing the chance of a lapsed authorization surfacing at claim time, and denials or missing-documentation issues reach your team faster, giving providers more time to respond.
We do not promise approval rates, turnaround times, or denial-appeal outcomes. Every authorization decision is made by the payer, based on the patient's plan and the payer's own criteria - that is true regardless of who submits or follows up on the request. What we control is thorough, timely administrative work: complete documentation submitted on time, consistent follow-up so requests don't stall, and fast escalation when something needs your team's attention.
Over time, that consistency compounds. A practice tracking status informally often can't answer, on any given day, exactly how many requests are open or which ones are overdue for follow-up - the honest answer is usually "we're not sure." A documented workflow replaces that uncertainty with a status your team can check at any point, which matters most on the days prior authorization isn't top of mind for anyone at the front desk.
No - and we want to be direct about that rather than imply otherwise. Payers make authorization decisions based on the patient's plan and their own clinical criteria. What we do is handle the administrative work around that decision as thoroughly as possible: identifying the requirement early, submitting complete documentation on time, following up consistently, and flagging denials or missing information back to your team fast enough to act on them.
We track the denial and escalate it to your team with the payer's stated reason, so your providers can decide how to proceed. Appeals that require clinical justification are a provider-directed process; we support the administrative filing of an appeal once your team has determined the clinical basis for it.
Your providers and practice determine what clinical documentation supports the request. We collect and submit that documentation as directed - we do not draft or judge clinical justification independently.
This is administrative submission, follow-up, and tracking work - not billing, coding, or claims processing. If you're also looking for revenue-cycle support, that's a separate Mednex Group brand, Practice Revenue Partners, linked in our footer.
That's within scope - phone follow-up on pending requests is one of the core tasks, worked on the payer's typical timeline and logged so your team can see exactly what was attempted and when.
Yes. Scope and volume are defined during onboarding to match the number of providers, specialties, and payer mix your practice or group works with.
That threshold is defined with your practice during onboarding, typically based on the payer's stated processing window for the service type. Once that window passes without a decision, the request is escalated rather than left in the queue.
No. Payers make authorization decisions, and clinical decisions remain with licensed providers. We manage the administrative submission and follow-up thoroughly, but approval is the payer's decision. Any service that promises guaranteed approvals is overstating what any administrative support role can do.
No. Medical necessity determinations are made by payers based on documentation your licensed providers supply; we do not make or influence that determination.
We identify gaps and escalate back to your team promptly so a provider or clinical staff member can supply what's missing. We don't generate clinical documentation to fill the gap.
Yes, tracking authorization status and expiration is part of this service, with proactive follow-up before lapse where possible.
Requirements vary by payer and plan. We check the payer's stated requirements for the specific service and plan combination using your practice's approved payer resources and portals.
We follow up with the payer on the timeline they typically require and log each contact. If a request stalls past what's reasonable for that payer, it's escalated to your team.
No. Clinical documentation and medical necessity justification are the responsibility of your licensed providers. We collect and submit what your practice provides; we do not draft or independently judge clinical content.
No. Communicating a denial and its clinical implications to a patient is a provider-directed conversation. We track and report the denial to your team; how it's communicated is your practice's decision.
Staff can be trained to support client-approved administrative workflows in commonly used EHR, practice-management, and payer-portal systems. Access depends on your credentials, training, and security requirements.
That depends on your defined workflow and the payer's own submission process. Requirement identification typically begins as soon as a service is scheduled and flagged in your system.
Scope is defined during onboarding and can include either or both, depending on what your practice needs tracked and the payer resources involved.
No PHI required for the initial conversation.
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