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Healthcare delivery is often slowed down long before treatment begins. Not because of clinical limitations, but because of administrative barriers that delay approvals and disrupt care timelines. We manage prior authorizations so these barriers don't hold up care. Every request is prepared, submitted and tracked until the payer decides. Approval is always the payer's decision.
Across healthcare systems, authorization requirements have become more demanding. Each payer introduces different rules, documentation standards, and approval criteria. As a result, pre-authorization management is often handled under pressure, with limited visibility and inconsistent processes.
Delays occur not by complexity alone, but by the lack of structure around it. Incomplete submissions, missed follow-ups, and poor authorization tracking lead to repeated denials. Patients are forced to wait. Providers are forced to rework. This is where the process begins to break.
Prior authorization shouldn't be reactive. We check each payer's authorization requirements before a request goes out, track every step, and follow up when a request stalls. We help you match documentation to Medicare, Medicaid and commercial payer requirements.
You shouldn't have to guess where a request stands. We track each authorization and tell you its status, what the payer still needs and what happens next.
2026 prior authorization rules (CMS): Since January 1, 2026, CMS rule CMS-0057-F requires Medicare Advantage plans, Medicaid and CHIP programs and their managed care plans to decide standard prior authorization requests within 7 calendar days and urgent requests within 72 hours. Denials must include a specific reason. These payers had to post their first public prior authorization metrics by March 31, 2026, and must add FHIR-based Prior Authorization APIs by January 1, 2027. Separately, CMS's WISeR model, which started January 1, 2026 and runs through 2031, adds technology-assisted prior authorization (or pre-payment review) for selected services in Original Medicare in New Jersey, Ohio, Oklahoma, Texas, Arizona and Washington.
Sources: CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F, released January 17, 2024) and CMS WISeR Model (announced June 27, 2025).
Different specialties bring different authorization challenges. Requirements vary, documentation differs, and approval timelines are not uniform. Our AAPC/CPC Certified Coders and Billers work to each practice's payers and specialty. We support radiology, oncology and pain management practices, among other specialties.
A complete, well-documented request gives the payer fewer reasons to pend or deny it. Fewer resubmissions mean less rework for your staff and fewer rescheduled appointments for your patients.
Healthcare operations are evolving, and authorization processes must evolve with them. We work inside your existing EHR/PM system and payer portals, including Epic, athenahealth, eClinicalWorks, NextGen, Tebra and AdvancedMD, so there's nothing to install. You keep ownership of your data. We're HIPAA compliant and our staff are HIPAA-trained. We tell you where requests are held up and why.
Speed doesn't come from rushing submissions. It comes from removing inefficiencies. We manage each request ourselves. We check the payer's requirements, gather the clinical documentation, submit, track, and follow up with the payer instead of waiting to hear back.
Prior authorization does not have to remain a point of friction. With the right structure, it can become a predictable and controlled process. Tell us which payers and services cause the most delays, and we'll show you how we'd handle them.
Common prior authorization questions we hear from healthcare providers.
Didn't find your question?
Contact usPrior authorization services involve managing the approval process that insurance providers require before certain treatments or procedures are performed. Getting authorization first helps avoid denials for a missing authorization, and approval is still the payer's decision.
The process can be improved through structured workflows, accurate documentation, proactive follow-ups, and electronic submission through payer portals where the payer offers it.
Outsourcing takes authorization paperwork and payer follow-up off your front desk and clinical staff, so they can spend that time on patients. Approval is still the payer's decision.
It's another name for prior authorization. Payers often use the term for hospital admissions and scheduled procedures. Eligibility checks are a separate step, done before the request.
We help reduce denials and delays with complete submissions, ongoing authorization tracking, payer-specific requirements and timely follow-up.
Book a free consultation and tell us where requests get stuck.
Authorization questions can also go to info@medixcode.com, or reach us through our contact page.