Payer Requirement Review
Identify authorization requirements, referral needs, medical policy criteria, plan rules, and service-specific documentation expectations.
Provider Services
Prior Authorization Management that keeps care moving.
Support authorization intake, documentation review, payer submission, status tracking, and escalation workflows with a trained healthcare operations team built for consistency and visibility.
01
Authorization Intake
Capture service details, payer rules, patient coverage context, and documentation needs before submission.
02
Payer Submission
Prepare and submit authorization requests through payer portals, forms, fax workflows, or client-defined channels.
03
Status Visibility
Track reference numbers, pending requests, payer responses, additional information needs, and approval outcomes.
Service Scope
What the workflow covers.
Prior authorization can slow access to care when requirements, documentation, and payer follow-up are not owned clearly. EmpireOneHealth helps structure the work so requests move with fewer blind spots.
Documentation Readiness
Check orders, clinical notes, diagnosis and procedure information, supporting records, and missing-item queues before submission.
Authorization Submission
Submit requests through payer portals, phone, fax, or other client-approved workflows while documenting confirmation details.
Status Follow-Up
Monitor pending authorizations, request updates, reference numbers, expected turnarounds, and payer response notes.
Exception Management
Route requests for additional information, peer-to-peer needs, adverse decisions, resubmissions, and appeal handoffs.
Reporting & Controls
Use QA sampling, aging views, queue summaries, and escalation reporting to keep authorization work measurable.
How We Work
A structured authorization workflow your team can trust.
The support model is designed around your specialties, payer mix, systems, turnaround goals, clinical handoff rules, and reporting expectations.
Authorization intake and request queue ownership
Payer criteria and documentation review
Submission tracking and reference number capture
Escalation, QA, and status reporting visibility
Prior Authorization Management