Prior authorization (PA) is often a necessary step in securing coverage for medical procedures, diagnostic tests, medications, and specialized services. Missing or incomplete prior authorization can result in delayed care, denied claims, and lost revenue — creating frustration for both staff and patients.
Reenix Excellence offers dedicated prior authorization services that take the burden off your clinical and billing teams. We handle the entire process, from gathering medical documentation to coordinating with insurance payers, ensuring that approvals are obtained efficiently and accurately.
Prior authorization is the process of obtaining approval from an insurance company before performing a service or procedure. This step confirms medical necessity and ensures the insurance payer will cover the cost of care.
We determine if prior authorization is required based on the patient’s insurance plan and the requested service or procedure.
Our team gathers and reviews necessary clinical documents, including referral notes, diagnoses, test results, and provider narratives.
We submit complete prior authorization requests through payer-specific channels — whether via portal, fax, or clearinghouse — with all required documentation.
We follow up on pending authorizations to ensure timely approvals and escalate cases if delays occur.
Your team is notified of approval status, reference numbers, and authorization details to support accurate claims submission.
If an authorization is denied, we assist in gathering additional documentation and filing a timely appeal to pursue approval.
We reduce the time between request and approval by submitting complete, payer-compliant documentation on the first try.
Our team understands authorization requirements across various specialties including imaging, cardiology, behavioral health, pain management, physical therapy, and more.
Proper documentation and proactive communication significantly lower the chances of authorization-related claim denials.
Free up your clinical and front-desk staff to focus on patient care while we manage the administrative legwork.
Receive daily status updates and authorization notifications via your preferred method — email, dashboard, or EHR system.
All data handling and payer interactions meet strict HIPAA standards to ensure full privacy and compliance.
Our solutions are designed for healthcare organizations of all sizes, including:
| Step | Action |
|---|---|
|
Service Verification |
Identify CPT codes, procedures, or medications requiring prior authorization |
|
Payer Requirement Lookup |
Determine the payer’s documentation and submission requirements |
|
Documentation Collection |
Gather clinical notes, referrals, lab results, and medical necessity evidence |
|
Submission to Payer |
Send authorization request via appropriate payer channels |
|
Ongoing Follow-Up |
Track request status, communicate with payers, and escalate delays |
|
Approval & Communication |
Share authorization results and next steps with your team |
|
Denial Response (if needed) |
File appeals with supporting clinical justification if an authorization is denied |
Prior authorization is the process of getting insurance approval before providing a medical service or prescription to ensure it’s covered. It confirms medical necessity and helps prevent denied claims.
Authorization timeframes vary by payer and service type, but our team typically secures approvals within 24–72 hours depending on urgency.
If denied, Reenix Excellence works with your team to gather additional documentation and submit a formal appeal promptly.
Yes. We can expedite urgent authorizations for same-day procedures when supported by clinical urgency.
Absolutely. Our workflows can be integrated with most practice management or electronic health record platforms.
Yes. We maintain strict data privacy and HIPAA compliance across all authorization processes.
Let Reenix Excellence take on the complexities of prior authorization so your team can focus on patient care. We streamline the process, reduce delays, and help you avoid unnecessary denials — all with full transparency and compliance.
