Managed payer administration for medical practices
Defined payer administration. Accountable delivery.
PriorDesk manages the administrative relationship between medical practices and payers, from patient access and treatment authorization through reimbursement, appeals, provider enrollment, and payer participation. Each engagement is structured around defined scope, operating capacity, documented activity, and clear responsibility.
A structured operating model for payer administration.
PriorDesk manages the administrative relationship between healthcare practices and payers, from patient access and treatment authorization through reimbursement, appeals, provider enrollment, and payer participation. Work is performed within practice-approved systems and authorized payer channels, with clear ownership, documented follow-up, and defined escalation pathways.
Services can be engaged individually or combined within a broader managed scope based on the needs of the organization.
Services
One operating model for the entire practice-to-payer relationship.
Patient access
Treatment authorization
Reimbursement
Appeals
Provider enrollment
Payer participation
Eight service lines across the lifecycle, engaged individually or combined within a defined written scope.
Eligibility, Benefits & Financial Clearance
Coverage, service-level benefits, patient-responsibility estimates, and pre-service financial-clearance status.
Referral Management
Referral requirements identified, obtained, tracked through visits and expiration, and documented.
Prior Authorization
Medical-benefit authorizations for procedures, imaging, infusions, injections, therapies, and equipment, from requirement through determination.
Medication Access & Pharmacy Benefits
Pharmacy-benefit and specialty-drug authorizations, exceptions, benefits investigation, and hub and assistance-program enrollment.
Claims & A/R Administration
Payer-facing claim status, aging accounts-receivable follow-up, and underpayment and recoupment follow-up.
Denials & Appeals
Denial research, appeal administration, deadline tracking, and denial trend reporting.
Credentialing & Payer Enrollment
Credentialing administration, CAQH, payer enrollment, revalidation, and licensing and privileging support.
Payer Contracting & Network Administration
Participation requests, contract administration, fee-schedule review, and negotiation support.
Not every service is included in every plan. The services, payers, and volumes in an engagement are defined in the written scope.
Payer administration requires dedicated operating capacity.
Payer work is distributed across portals, telephone workflows, documentation requirements, status systems, and follow-up timelines. When ownership is fragmented across practice staff, administrative work competes with other operating responsibilities.
PriorDesk provides defined capacity for payer-facing workflows and clear ownership of the work included in scope.
- Eligibility, benefits, and financial clearance
- Referrals and prior authorization
- Medication access and pharmacy benefits
- Claims and accounts-receivable follow-up
- Denials and appeals
- Credentialing, enrollment, and payer contracting
Built for independent practices and healthcare organizations.
PriorDesk works with independent medical practices and healthcare organizations that have enough payer-related administrative volume to need consistent support, but do not want to build another internal department to manage it.
- Dermatology
- Orthopedics
- Cardiology
- Rheumatology
- Gastroenterology
- Neurology
- Pain Management
- ENT
- Allergy & Immunology
- Infusion Practices
- Other Independent Specialty Practices
Not sure whether your workflow fits? We can review the work your team is currently handling and determine whether it belongs with PriorDesk.