Services
Prior authorization support before the patient arrives
We verify coverage and benefits, check pre-auth requirements for each service, track the clinical documentation needed and coordinate referrals, so gaps surface before the visit.
| Code | What it means |
|---|---|
CARC CO-197 | Precertification or authorization absent |
CARC CO-15 | Authorization number missing, invalid or does not apply |
CARC = claim adjustment reason code, as printed on your remittance.
Prior authorization is time-sensitive work that pulls your staff away from patients. Requirements differ by payer, plan and service, and they change often.
Medwiser’s team verifies coverage, checks each scheduled service against the payer’s requirements and tracks the documentation involved, so your staff can see what is outstanding.
What's included
- Coverage & Benefit Verification (VOB)Patient coverage and benefits are verified for scheduled services.
- Service-Specific Pre-Auth Requirement ChecksScheduled services are checked against the patient's plan and the payer's current authorization requirements.
- Clinical Documentation TrackingThe clinical notes and forms a payer asks for are tracked, so missing items are visible early.
- Referral CoordinationReferrals are coordinated with your team, so the right referral is on file before the visit.
Where revenue leaks
The problems we work on
Services performed without an authorization
A missed requirement means a denial that is hard to overturn. We check requirements when visits are scheduled rather than on the day.
CARC CO-197Precertification or authorization absent
Authorization doesn't match the claim
Approved codes, units or dates that differ from what was billed cause denials even when an authorization exists. Tracked documentation helps your team spot a mismatch before the claim goes out.
CARC CO-15Authorization number missing, invalid or does not apply
Missing clinical documentation
Requests held up for missing notes delay care. We track what each payer asks for, so gaps are visible ahead of the appointment.
How it works
Getting started with prior authorization
Map your requirements
Standard BAA executed prior to system access. We then list the services you schedule most and the payers that require authorization for them.
Connect to scheduling
We get access to your schedule, so upcoming visits can be checked.
Verify and track
Coverage, benefits and pre-auth requirements are checked, and documentation needs are tracked.
Review
Open gaps and authorization-related denials are reviewed with you.
Benchmarks
Benchmarks to measure against
Common industry benchmarks and, where noted, our service targets. We can measure your baseline in a free review.
FAQ
Prior Authorization: common questions
Which services do you support?
Tell us the services and plans you work with most, such as procedures, advanced imaging and therapy visits, and we will confirm how we can support them.
How much notice do you need before an appointment?
The more the better. Earlier scheduling gives more time to verify coverage, check requirements and track documentation.
Can we use this if we do our own billing?
Yes. Prior authorization support is available on its own and works with whichever team submits your claims.
What happens if an authorization is denied?
We flag the payer's response to your team, along with any documentation that is outstanding. Our Denial Management & Appeals service can support you from there.
Related services
Often paired with
Denial Management & Appeals
Denials categorized by reason code, reviewed and traced back to their root cause.
- Categorized by CARC and RARC
- Coding and modifier review
- Root-cause trend analytics
Medical Billing
Eligibility review, daily charge entry, coding support and electronic claim submission.
- Patient demographic and eligibility review
- Daily charge entry
- Clearinghouse rejection management
Authorization support
Spot missing authorizations earlier
Tell us which services and payers cause the most delays, and we will show you how we would support them.