Questions practices ask

A standard case is one authorization request for one ordered service, procedure, or medical-benefit therapy. It includes review and organization of documentation already in your record, written identification of any missing documentation for your team to supply, submission through the channel your practice approves, status monitoring, up to two routine payer follow-up contacts after submission, coordination of routine additional-information requests using documentation already in the record, and documentation of actions, reference numbers, status, and outcome in your authorized system. If the case is denied, we log and summarize the payer’s stated reason, the deadline, and the stated next step.

We log the denial in your system and summarize the payer’s stated reason, the appeal deadline, and the next step the payer has stated. That much is part of a standard case. Preparing the written appeal itself is a separately priced add-on.

No. Written appeal preparation is priced separately and confirmed with your practice before any appeal work begins. PriorDesk prepares the administrative portion of the appeal for your provider’s review and signature. We do not sign the appeal, make the clinical argument, or conduct a peer-to-peer review.

It is a separate service, from $25 a case, for medical-benefit authorization requests your practice has already submitted. PriorDesk reviews the available status, completes one follow-up cycle with the payer, and documents the outcome in your authorized system. One follow-up cycle means reviewing the available authorization information, checking the payer portal when applicable, completing one payer telephone follow-up when needed, obtaining and documenting the current status, reference number, missing requirement, or payer-directed next step, and recording the outcome in your authorized system. It is not a standard complete prior authorization case. Additional follow-up cycles, documentation preparation, resubmissions, denials, and written appeals are outside this service and require separate approval and pricing.

A case that requires repeated payer contacts beyond the routine follow-up in a standard case, unusual documentation, multiple authorization requests for a single episode of care, retroactive work, or work materially outside the standard scope. These are reviewed and priced with your practice before the additional work begins.

Up to two routine payer follow-up contacts after submission are included in a standard case. Further follow-up cycles are reviewed and priced separately, and we do not perform them without your approval.

No. PriorDesk handles medical-benefit authorizations: procedures, injections, surgeries, office-administered therapies, and the imaging your physicians order. Pharmacy-benefit prior authorizations, the kind filled at a retail or mail-order pharmacy, are not in our current offer.

No. Clinical decisions, medical necessity determinations, selection or alteration of diagnosis and procedure codes, 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. Payer determinations and payer response times are outside our control. Nothing on this website is a guarantee that an authorization will be approved, that an appeal will succeed, or that a payer will respond within a particular period.

Small, independent outpatient specialty practices with recurring monthly medical-benefit authorization volume that do not need, or cannot justify, another full-time authorization employee. We support outpatient specialties including orthopedics, spine, pain management, dermatology, oncology, and infusion practices, and we are not limited to that list.

$390 covers ten standard medical-benefit prior authorization cases. There is no monthly subscription and no long-term commitment. It is designed for practices that want to evaluate the workflow before choosing ongoing support. The scope is confirmed in the service agreement before work begins.

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.

We tell you before the additional work happens. Cases beyond the included monthly capacity are confirmed and priced with your practice in advance. We do not perform work beyond the agreed scope without your approval.

Authorization software is built for clean, structured submissions and does that well. PriorDesk is built for the cases that still need documentation coordination, payer contact, status management, and human follow-through after the submission. Unlike a general virtual assistant, the work is specific to medical-benefit prior authorization, performed inside your systems, under a Business Associate Agreement, with every action documented.