Questions practices ask

No. Monthly case and verification allowances reset each billing period and unused volume does not roll over.

Additional volume is billed at the applicable contracted case rate. Practices with consistently higher volume can move to a larger plan or request a custom monthly scope.

Yes. Prior Authorization, Eligibility & Benefits, and Claims & A/R are available as individual service desks. Denials & Appeals and Credentialing & Payer Enrollment are priced per item or per provider.

Yes. Payer Desk plans combine Prior Authorization, Eligibility & Benefits, and Claims & A/R follow-up under one monthly scope. Other services can be added to an engagement under their own scope and pricing.

No. A Payer Desk plan covers the three workflows and monthly volumes listed on the plan. Denials and appeals, credentialing and enrollment, medication access, referral management, and payer contracting are engaged separately.

As high-touch case work, a project with a defined start and finish, or a custom-scoped engagement, depending on what the work is. Each is written into the scope before it begins, with its own pricing, so a monthly plan is never silently stretched to cover work it was not built for.

They are scoped and priced in writing after a review of the work involved, because the volume and complexity vary substantially by practice and payer environment. There is no published monthly price for these services.

No. Formal denial and appeal work is priced separately because the administrative workload can vary significantly by case.

No. Credentialing & Payer Enrollment is a separately priced service.

No. PriorDesk provides payer-facing claims and accounts-receivable administration. It does not include coding, charge entry, patient collections, patient statements, or full-service medical billing.

No. Authorization, appeal, enrollment, credentialing, contracting, and payment decisions are made by the applicable payer or organization.

No. Practices engage PriorDesk for a defined managed service. PriorDesk is responsible for resourcing and managing delivery of the contracted workflow.

Yes. Medication Access & Pharmacy Benefits is a service line in its own right. PriorDesk determines whether a medication processes under the medical or pharmacy benefit, verifies pharmacy benefits, administers pharmacy-benefit and specialty-drug prior authorizations and exceptions, and manages hub, copay, and assistance-program enrollment. Medical-benefit authorizations for procedures, imaging, injections, infusions, therapies, and equipment are handled under Prior Authorization.

No. Clinical decisions, medical-necessity determinations, prescribing decisions, selection or alteration of diagnosis and procedure codes, physician peer-to-peer reviews, provider signatures, and clinical answers to payer questions stay with your practice and your licensed clinicians. PriorDesk does not speak as the treating provider.

No. PriorDesk performs payer-facing claims and accounts-receivable administration: claim status, follow-up, missing-information resolution, underpayment and recoupment follow-up, and corrected-claim coordination when the corrected billing information is supplied. It does not perform coding, charge entry, routine claim creation, patient collections, patient statements, or full-service medical billing, and it complements a billing team or billing company rather than replacing one.

Independent medical practices and healthcare organizations with recurring payer-administration workload and limited internal capacity to own it. We support outpatient specialties including orthopedics, spine, pain management, dermatology, oncology, infusion, rheumatology, gastroenterology, and neurology, and we are not limited to that list.

No. PriorDesk works inside the systems your practice already uses and authorizes: your EHR or practice-management system, payer portals, PBM and specialty-pharmacy platforms, clearinghouses, and CAQH and PECOS. Your practice provisions the accounts, sets the permissions, and can revoke access. There is no separate PriorDesk patient database.

Payer activity is documented within the practice-approved systems used for the engagement, with each case carrying its current status, the last payer action, the next follow-up, and any deadline. Where supplemental operational tracking is used, it is aggregate and contains no protected health information. Reporting appropriate to the engagement covers case status, deadlines, determinations, unresolved issues, escalations, and recurring administrative barriers. Reporting describes activity and status; turnaround and outcomes are decided by the payer.

As a provisioned user, under accounts your practice creates and can revoke, after a Business Associate Agreement is executed and the security, training, device, and access requirements in your scope are complete. Work is performed inside your systems. PriorDesk does not maintain a separate patient database.

PriorDesk is a managed service rather than a software platform or a placement. We perform the administrative work included in the contracted scope through practice-approved systems and payer workflows, and we are responsible for managing delivery of that scope. The practice is purchasing defined operating capacity and workflow ownership, not a software license and not an individual worker.