How PriorDesk works
A defined process from intake to follow-up.
We agree on the work PriorDesk will own, establish the workflow, and give your team a clear way to send cases to us and receive status back.
The process
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Define the Scope
We review the payer-administration workflows to be assigned to PriorDesk, expected volume, payer mix, systems involved, operating requirements, and responsibilities.
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Configure Access
The practice provisions the approved systems and access required for the contracted services.
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Begin Delivery
PriorDesk performs the payer-facing administrative work included in the contracted scope.
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Document Activity
Actions, payer reference numbers, requirements, statuses, and outcomes are documented in the authorized workflow.
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Review
The practice receives operating visibility appropriate to the engagement.
Capacity without another direct hire.
PriorDesk provides a managed administrative service rather than placing an individual worker inside your practice. We define the workflow, manage delivery, document activity, and remain accountable for the contracted scope.
The scope stays defined.
PriorDesk is not an open-ended virtual assistant service. The work we own is documented at the beginning of the relationship so your team knows what comes to us, what remains with the practice, and how exceptions are handled.
No PHI is requested during partnership evaluation or scoping.
Work stays inside your existing systems
PriorDesk performs contracted work through the systems your practice authorizes for the assigned workflow: the EHR or practice-management system, payer portals, pharmacy benefit manager and specialty-pharmacy platforms, clearinghouses, CAQH and PECOS, and authorized payer telephone channels. There is no separate PriorDesk patient database to move work into, and the practice decides what access each engagement receives.
- The work is performed by PriorDesk’s own team as a managed service
- PriorDesk personnel are U.S.-based
- PriorDesk personnel are trained for the payer-administration workflows included in their assigned scope.
- Personnel complete required privacy and security training before being granted access to client PHI and receive refresher training in accordance with PriorDesk policy
- User accounts are provisioned and controlled by the practice
- The practice can modify or revoke access
- Case activity is documented in the practice’s authorized system
- PriorDesk does not maintain a separate patient database or duplicate patient roster outside the practice’s systems
Reporting and accountability
Managed payer work is only useful if the practice can see it. PriorDesk documents payer activity within the practice-approved systems used for the engagement, with supplemental operational tracking where appropriate, so that the current status, the last payer action, the next follow-up, and any deadline or expiration date are visible to the practice.
Supplemental tracking is aggregate and contains no protected health information; patient-level case detail remains in the practice’s systems, consistent with the operating model described on the Security page. Reporting appropriate to the engagement is delivered from those records. Depending on scope it may include:
- Active cases and current status
- Aging, pending reasons, and last payer action
- Next follow-up and assigned owner
- Deadlines, appeal windows, and expiration dates
- Authorization determinations and referral and enrollment outcomes
- Unresolved issues and escalation status
- Payer follow-up history, including reference and call numbers
- Trends and recurring administrative barriers by payer and by service
The point of the record is accountability: the practice can see what was done, what is waiting on whom, and what will happen next. Reporting describes activity and status. It does not promise turnaround or outcomes, which are decided by the payer.
When a case requires clinical input
PriorDesk handles the administrative workflow. The practice and its licensed clinicians retain responsibility for:
- Clinical decisions
- Medical-necessity determinations
- Diagnosis and procedure code selection
- Changes to diagnosis or procedure codes
- Treatment recommendations
- Clinical answers to payer questions
- Peer-to-peer reviews
- Provider signatures and attestations
- Clinical arguments included in an appeal
When a payer requests clinical input, PriorDesk documents the request and directs it to the appropriate practice representative.
Begin with your practice workflow
Tell us which payer-administration workflows you need help with, your approximate monthly volume, the size of your practice, and how your team handles the work today.
We will review the information and provide the appropriate service recommendation, written scope, pricing, and onboarding requirements.
No patient information is requested or accepted through this website.
PriorDesk does not guarantee payer approval or payer response time.