Prior Authorization Services That Keep Care and Billing Moving
Get the right information, documentation and next action in place before an authorization delay becomes a patient-access or billing problem. We combine technology-enabled tracking, payer-aware workflows, human exception handling and authorization-to-claim visibility to keep the authorization requests moving.
Why Prior Authorization Demands Organized Workflows
Prior authorization is one of the most demanding workflows in the revenue cycle. Requirements vary by payer, plan, procedure, medication, specialty and site of care.
We help practices manage these workflows with organized authorization tracking workflows, payer-aware follow-up and clear escalation with human review.
Shoreline's Prior Authorization Workflow
A disciplined, end-to-end operational protocol from pre-service discovery to final billing alignment.
Identify authorization requirements before the service
We review authorization requirements through approved payer and practice workflows. Our team helps to determine whether the scheduled service may require prior authorization, pre-certification, referral review or additional payer documentation before care is delivered.
Use service-specific documentation checklists
Using generic documentation requests might create rework. We organize client-approved checklists for high-volume or complex services so that our team is aware of the details that might be required before submission.
Submit through the appropriate payer channel
Depending on availability and client-approved access, all requests are moved through electronic prior-authorization tools, payer portals, fax or phone-based follow-up.
Track status and resolve information requests
Our authorization work does not end after submission. We track pending requests, additional-information requirements, approval details, denials, expiration dates and the next action needed. All time-sensitive matters are routed through defined escalation paths, so they do not remain hidden in an unworked queue.
Match the authorization to the billed service
We align the approval with the service performed, helps to organize authorization records including applicable dates, services, units, providers or locations so they can be reviewed alongside eligibility, charge capture and claim-submission workflows.
Practical Technology with Human Oversight
We combine electronic prior-authorization tools, rules engines and interoperability standards with expert review:
- Electronic PA systems & intelligent rules engines to reduce manual entry
- Experienced RCM specialists review clinical & billing exceptions
- Zero reliance on vague automation claims or black-box logic
- Seamless integration with your practice EMR/EHR scheduling workflows
A Better Operating Model for Complex Payer Rules
For recurring, high-volume services, we help practices to build authorization playbooks that bring together:
- Payer and plan requirements
- Required documentation and checklist items
- Procedure and diagnosis-code references where appropriate
- Submission channel and follow-up cadence
- Escalation contacts and client decision points
- Approval tracking and claim-handoff requirements
What does Shoreline's Prior Authorization Support Includes?
Identification of authorization requirements through approved payer and practice workflows
Collection and organization of required non-clinical and client-approved documentation
Submission through supported electronic, portal, fax or payer channels
Tracking of authorization status, reference information and decision dates
Follow-up on pending requests and additional-information requirements
Documentation of approval, denial, expiration, service and authorization details
Handoff of approved authorization information to scheduling, billing and claim-submission teams
Reporting on authorization volume, aging, pending cases and recurring payer issues
Never Miss an Authorization Deadline Again
Contact our RCM Expert to handle your prior authorization workflows so you never lose revenue to delays.