For outpatient practices
Give payer work somewhere to go.
PriorDesk supports independent practices that need reliable administrative capacity without immediately adding another full-time internal role.
PriorDesk may be a fit for practices with:
- Recurring payer-administration workload
- Eligibility, benefits, and financial-clearance volume
- Referral and prior authorization volume
- Specialty medication and pharmacy-benefit access requirements
- Claims requiring payer follow-up and aging accounts receivable
- Denial and appeal workload
- Credentialing, enrollment, licensing, and payer-contracting activity
- Internal capacity constraints and a need for defined external workflow ownership
What PriorDesk does not replace.
PriorDesk does not replace your physicians, clinical staff, practice management, coding team, or billing system. We take ownership of defined payer-facing administrative workflows that would otherwise remain on their desks.
Buy the workflow, not another employee.
PriorDesk is a managed service. Your practice defines the payer-administration work you want us to own, and PriorDesk manages the resources, process, follow-up, and reporting required to deliver it.
That means your team does not have to recruit, train, schedule, or supervise another administrative employee simply to move payer work forward.
Support across independent medical specialties.
PriorDesk supports defined payer-administration workflows across a range of independent medical specialties. The service mix depends on practice requirements, payer environment, volume, systems, and workflow complexity.
Payer administration by specialty:
- Orthopedics, spine, and pain management
- Dermatology
- Oncology and infusion practices
- Rheumatology
- Gastroenterology
- Neurology
- Ambulatory surgery centers
PriorDesk supports medical-benefit and pharmacy-benefit workflows. The payers, programs, and workflows included in an engagement are defined in the written scope.
Billing and RCM companies can work with PriorDesk through white-label or referral arrangements. See For billing companies.
How PriorDesk enters your workflow
Practice review
Tell us about your specialty, approximate monthly volume, payer environment, and the type of support you need.
No patient information is requested or accepted through the public website.
Written scope and pricing
PriorDesk reviews the requested workflow and provides a written proposal identifying the services, responsibilities, case capacity, pricing, and onboarding requirements.
Agreement and access
Before live work begins, the Business Associate Agreement is completed and the applicable security, training, device, and access requirements are established.
The practice provisions and controls the accounts and permissions used by PriorDesk.
Administrative casework
PriorDesk performs the contracted payer-administration work inside the practice’s authorized systems and documents actions, payer reference numbers, requirements, statuses, and outcomes.
Clinical escalation
Questions requiring clinical judgment, medical-necessity decisions, coding decisions, provider attestations, or peer-to-peer review are returned to the appropriate practice representative.
Clear responsibilities within every engagement
PriorDesk responsibilities are defined by service scope so the practice, PriorDesk, and any partner organization understand where administrative ownership begins and ends.
PriorDesk handles
Within the contracted scope, PriorDesk can:
- Perform the payer-administration workflows defined in the applicable Service Order
- Work through practice-approved payer portals, systems, and authorized telephone channels
- Prepare and organize administrative documentation available within the approved workflow
- Identify missing information for the practice to provide
- Submit administrative requests and materials where applicable to the contracted service
- Monitor status and perform payer follow-up within scope
- Coordinate routine payer requests using information available within the authorized workflow
- Record actions, payer reference numbers, requirements, statuses, and outcomes
- Escalate matters requiring clinical judgment, coding decisions, provider signatures, or responsibilities retained by the practice
Your practice retains
The practice and its licensed clinicians retain responsibility for:
- Clinical decisions
- Medical-necessity determinations
- Diagnosis and procedure code selection or modification
- Clinical answers to payer questions
- Peer-to-peer reviews
- Provider signatures and attestations
- Treatment decisions
- Final review and signature of any written appeal
Formal appeals, credentialing and enrollment, medication access, referral management, payer contracting, and work outside the contracted scope require separate approval and pricing.
A defined operating approach
Every PriorDesk engagement is structured around:
- U.S.-based support: Contracted work is performed by personnel located in the United States.
- PriorDesk’s team: Each engagement is supported by PriorDesk’s U.S.-based team, trained for the payer-administration workflows included in the contracted scope. Work is performed through the practice-approved systems and payer channels required for that engagement after onboarding and access are complete.
- Practice-controlled access: The practice provisions, controls, and can revoke system access.
- Written service scope: Responsibilities, capacity, pricing, and exclusions are documented before service begins.
- Documented activity: Work is recorded in the practice’s authorized system.
- Administrative boundaries: Clinical and coding responsibilities remain with the practice.
- Approved additional work: Services outside the agreed scope require practice approval before they are performed.
PriorDesk does not guarantee payer approval or payer response time.
Begin with a clear practice review
Tell us about the payer work your practice is handling now and the support your practice needs. We will review the information and provide the appropriate service recommendation, scope, and next steps.
PriorDesk does not request or accept patient information through this website.