Oncology and infusion
Payer administration for oncology and infusion practices
Infusion and office-administered therapy authorizations, medical-versus-pharmacy benefit determination, specialty medication access, benefits investigation and financial clearance, and the claims, denials, and appeals that follow, handled within your systems by PriorDesk’s U.S.-based team. Your clinicians keep every treatment decision.
What lands on our desk
- Office-administered therapies billed under the medical benefit, including chemotherapy, immunotherapy, supportive-care infusions, immune globulin, and biologic infusions for rheumatology and gastroenterology
- Determination of whether each therapy processes under the medical or pharmacy benefit, and the pharmacy-benefit authorization when it does
- Benefits investigation, patient-responsibility estimates, and financial clearance before the first chair
- Specialty-pharmacy, hub, copay-card, and foundation or assistance-program enrollment for high-cost therapies
- Advanced imaging orders, including PET and CT
- Site-of-care and continuation-of-therapy requirements that payers attach to infusion authorizations
- Claim follow-up, underpayment identification, and denial and appeal administration for infusion and drug claims
- Payer enrollment and credentialing for infusion providers and locations
Administrative demands in oncology and infusion
Infusion and oncology payer work involves extensive clinical documentation, treatment-specific criteria, and ongoing status follow-up. Drug, dose, frequency, diagnosis, line of therapy, prior treatments, and the site where the therapy is given are each checked against a payer policy that changes, and the same drug may process under the medical benefit for one payer and the pharmacy benefit for another. The financial exposure on a single chair is high enough that benefits investigation and financial clearance belong before the first dose, and denials and underpayments need to be worked while the appeal window is open. Many practices already use an authorization platform for buy-and-bill drugs. PriorDesk works alongside the tools your practice already uses and takes the cases that still need documentation coordination, payer contact, and follow-up.
How a case runs here
PriorDesk locates and organizes the documentation the payer’s published criteria require, flags anything missing to your coordinator, submits through the channel your practice approves, monitors status, completes routine payer follow-up, coordinates routine additional-information requests from the record, and records every action, reference number, and outcome in your system. If a request is denied, PriorDesk records the payer’s stated reason, the deadline, and the directed next step, and administers the appeal where that is in scope.
What stays with your practice
Treatment decisions, medical necessity, prescribing decisions, diagnosis and procedure code selection, physician peer-to-peer reviews, provider signatures and attestations, and clinical answers to payer questions remain with your clinicians. When a payer asks a clinical question, PriorDesk documents it and routes it to the contact you designate.
Get started with PriorDesk
Tell us about your practice, your approximate monthly volume, and the support you need. We review your workflow, confirm the scope, and send the agreement and onboarding documents. No patient information is requested or accepted.