Prior Authorization Services

Authorization Requirement Verification

We identify whether prior authorization is required based on insurance payer guidelines, procedure and diagnosis codes (CPT, HCPCS, ICD-10), and provider specialty and service location. This step ensures no services are performed without required approvals.

Authorization Request Preparation

Our specialists prepare complete and accurate authorization requests. Thorough submissions reduce payer delays and rejections.

• Provider and facility details
• Patient demographics and insurance information
• CPT, HCPCS, and ICD-10 codes
• Clinical documentation supporting medical necessity
• Referring provider information (when applicable)

Submission to Insurance Payers

We submit prior authorization requests to Medicare Advantage plans, Medicaid programs, Commercial and private insurance carriers, and Managed care organizations. Requests are submitted through payer portals, fax, or electronic systems as required.

Payer Communication & Follow-Up

PlusMed Solutions communicates directly with insurance companies to monitor authorization status, respond to requests for additional clinical documentation, and follow up on pending approvals. Our proactive follow-up helps secure approvals within payer timelines.

Authorization Approval Tracking

Once authorization is approved, we record authorization numbers, track approved services, visits, and units, and monitor authorization effective and expiration dates. This ensures services are delivered within approved parameters.

Authorization Denial Review & Appeals

If an authorization request is denied, our team reviews the reason for denial, collects additional clinical documentation, and submits reconsiderations or appeals when appropriate. This process helps recover approvals and prevent lost revenue.