A growing share of services, procedures, imaging, and medications now need a payer’s approval before they’re delivered — and a missing or late authorization is an automatic denial your practice can’t bill its way out of. Health XRCM’s prior authorization services manage the entire process for you: checking whether a service needs approval, submitting complete requests with the right clinical documentation, tracking every request to a decision, and keeping your schedule moving instead of stalling on payer hold times.
Prior authorization (also called precertification or pre-auth) is a payer’s requirement that a service, procedure, or medication be approved as medically necessary before it is provided. Requirements vary by payer, plan, and procedure code — the same service may need authorization under one plan and not another. If the service is delivered without a required approval, the claim is denied and the cost usually cannot be recovered, which is why authorization has to be handled as a disciplined workflow, not a last-minute phone call.
Authorizations eat staff hours in portal queues and phone trees, and every missed one becomes a denial or a delayed appointment. A dedicated team that checks requirements early, submits complete documentation, and chases every open request means fewer authorization denials, fewer rescheduled patients, and a front office that can focus on patients. It connects directly with our eligibility verification and denial management services, so approvals, claims, and appeals all line up.
Which services typically need prior authorization?
Advanced imaging, surgeries and procedures, specialty medications, durable medical equipment, and many behavioral health and therapy services — but the list is set by each payer and plan, which is why we check every scheduled service individually.
How long does an authorization take?
Timelines are set by the payer and vary by plan and urgency. Because we submit requests as soon as services are scheduled — with complete clinical documentation — your patients aren’t waiting on avoidable back-and-forth.
What happens if an authorization is denied?
We support the appeal or peer-to-peer review with the clinical documentation, and where a service was already delivered, we pursue retro-authorization options where the payer allows them.
Don’t let authorization delays decide your schedule. Call (505) 274-7878 or book a free assessment.
