Prior authorizations
Benefit checks, documentation chased from the prescriber, and the authorization tracked to a decision.
- Benefit check
- Complete
- Clinical documentation
- Received
- Submission
- Filed
- Decision
- Approved
- Renewal date tracked
- ✓
Four things, tracked to a decision
Prior auths opened, submitted and followed up until they are approved or formally denied.
Prescriber offices chased for the clinical documentation, so your staff are not on hold.
Renewals tracked before they lapse, which is what turns an approved therapy into a rejected refill.
Specialty and high-cost therapies handled as the slow, documented cases they are.
What actually happens
The benefit is checked and the requirement confirmed before anything is filed, so the case opens against the right plan and the right criteria.
The request goes in with the clinical documentation attached, chased from the prescriber office rather than requested and forgotten.
Approved therapies are tracked toward their expiry and renewed ahead of it, which is what keeps a refill from rejecting at the counter.
What we take on
Our desk- 01Opening and submitting prior authorizations
- 02Chasing prescriber offices for documentation
- 03Following every case to a formal decision
- 04Tracking renewals before they lapse
- 05Handling specialty and high-cost therapies
What stays yours
Unchanged- Your dispensing system and your data inside it
- Your payer contracts and your relationships
- The way a prescription gets filled at the counter
- Final say on anything written off or appealed
- The ability to see every claim we touched
Before you ask
No. Chasing the clinical documentation is part of the work, which is the part that usually puts a technician on hold for an afternoon.
A formal denial is a decision, and it comes back to you with the reason and the appeal options rather than as a dead end.
They are tracked against their expiry date and opened before it, because an approved therapy that lapses rejects exactly like an unapproved one.
They are handled as the slow, documented cases they are, with the paperwork assembled up front rather than chased after a rejection.
Works well alongside
Talk to us about your pharmacy
Send a month of remittances and we will show you what is being left behind before you commit to anything.