PriorDesk Pricing
Defined payer-administration services with transparent monthly capacity.
PriorDesk offers individual service desks and multi-service Payer Desk plans with defined scope, monthly capacity, and published pricing. Practices may engage a single payer-administration workflow or combine prior authorization, eligibility and benefits, and claims follow-up within one managed service. Services that vary substantially by engagement are scoped and priced in writing.
How engagements are structured
Not every service line is included in every monthly plan. Work is structured in the form that fits it, and the structure is written into the scope before work begins.
- Recurring managed support: Individual service desks and Payer Desk plans with published monthly capacity.
- Standard case work: Routine authorizations, verifications, and claim follow-ups counted against the monthly allowance.
- High-touch and complex cases: Multi-level appeals, complex specialty medication access, and similar work, scoped and priced on its own terms.
- Project-based services: Credentialing and enrollment projects, hospital and ASC privileging, licensing, and payer recovery projects with a defined start and finish.
- Custom-scoped engagements: Payer contracting and network administration, and any engagement that does not fit a published plan.
Individual Service Desks
Individual Service Desks provide defined monthly capacity for practices that require support within a specific payer-administration workflow.
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Authorization Desk
Managed medical-benefit prior authorization support from requirement determination and submission through payer follow-up and determination documentation.
- $995/month30 prior authorization cases
- $1,795/month60 prior authorization cases
- $2,695/month100 prior authorization cases
Included:
- Authorization requirement determination
- Benefit checks related to the request
- Payer portal, fax, and telephone submissions
- Documentation collection and completeness review
- Status follow-up and additional-information requests
- Authorization verification and expiration tracking
- Administrative escalation
- Determination documentation
Choose Authorization SupportPharmacy-benefit and specialty medication authorizations are handled under Medication Access & Pharmacy Benefits, which is scoped separately.
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Eligibility & Benefits Desk
Eligibility, service-level benefit verification, and pre-service financial-clearance status, using payer portals and direct payer contact when portal data is insufficient.
- $595/month75 verifications
- $995/month150 verifications
- $1,695/month300 verifications
Included:
- Active coverage, effective dates, and termination dates
- Plan and product identification
- Primary and secondary coverage identification
- Deductible, copay, coinsurance, and out-of-pocket information when available
- Coverage limitations and visit, unit, and frequency limits
- Referral and authorization requirement checks
- Payer telephone verification when required
- Patient-responsibility estimate from available payer information
- Financial-clearance status documentation
Choose Eligibility & BenefitsVerification reflects information provided by the payer and does not guarantee payment. Insurance discovery and referral management are scoped separately.
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Claims & A/R Desk
Payer-facing follow-up for submitted claims that require status research, missing-information resolution, administrative clarification, or additional payer action.
- $595/month40 claims
- $1,295/month100 claims
- $2,295/month200 claims
Included:
- Claim-status research through payer portals and telephone
- Pending, stalled, and aging claim follow-up
- Missing-information resolution
- Administrative hold and coordination-of-benefits follow-up
- Medical-record request coordination
- Reprocessing-request follow-up
- Payer correspondence and escalation
- Reference and call-number documentation
- Status reporting to the practice
Choose Claims & A/RDoes not include medical coding, charge entry, patient collections, or full-service medical billing. Underpayment recovery follow-up and recoupment response projects are scoped separately.
Multi-service support
The PriorDesk Payer Desk
For practices managing several payer workflows at once, the Payer Desk combines prior authorization, eligibility and benefits verification, and claims follow-up under one monthly scope.
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Practice Payer Desk
$1,995per month
Includes:
- 30 Prior Authorization Cases
- 75 Eligibility & Benefits Verifications
- 40 Claims Follow-Ups
- Payer Calls
- Status Documentation
- Workflow Management
- Monthly Reporting
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Most Popular
Group Payer Desk
$3,695per month
Includes:
- 60 Prior Authorization Cases
- 150 Eligibility & Benefits Verifications
- 100 Claims Follow-Ups
- Payer Calls
- Status Documentation
- Workflow Management
- Monthly Reporting
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Multi-Location Payer Desk
$5,995per month
Includes:
- 100 Prior Authorization Cases
- 300 Eligibility & Benefits Verifications
- 200 Claims Follow-Ups
- Payer Calls
- Status Documentation
- Workflow Management
- Monthly Reporting
Payer Desk plans include the monthly volumes shown above. Additional volume is billed at the applicable contracted case rate. Unused monthly volume does not roll over.
Denials and appeals, credentialing and payer enrollment, medication access, referral management, and payer contracting are priced or scoped separately and do not reduce Payer Desk monthly case allowances.
Denials & Appeals
A formal appeal can require substantially more administrative work than routine claim or authorization follow-up. PriorDesk prices that work separately so the scope remains clear.
- Individual Administrative Appeal$125per appeal
- Appeal Pack$99510 administrative appeals
Included:
- Denial-reason research and categorization
- Timely-filing and coordination-of-benefits investigation
- Appeal packet assembly and supporting-document coordination
- Reconsideration and first-level appeal submission
- Peer-to-peer scheduling and administrative preparation
- Appeal deadline tracking
- Payer follow-up and escalation
- Outcome documentation
- Denial trend reporting
Clinical appeal content requiring medical judgment remains the responsibility of the treating provider or appropriate clinical staff.
Additional administrative appeal levels are scoped separately.
PriorDesk does not guarantee that an appeal, authorization, or claim will be approved or paid.
Credentialing & Payer Enrollment
Credentialing administration and payer enrollment are priced by provider and payer so practices can use PriorDesk for a single enrollment or an entire provider onboarding project. CAQH, revalidation, roster and demographic maintenance, and expirable tracking are covered by the maintenance service.
- Commercial Payer Enrollment$249per provider, per payer
- Medicare or Medicaid Enrollment$349per provider, per program
- CAQH Setup or Full Cleanup$299per provider
- Credentialing Maintenance$129/monthper provider
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New Provider Enrollment Package
$1,995
A defined enrollment package for practices bringing a new provider into their payer network.
Includes:
- CAQH setup or full audit
- Medicare enrollment, including PECOS
- Medicaid enrollment
- Up to five commercial payer applications
- Application preparation and submission
- Missing-information follow-up and payer correspondence
- Status checks and follow-up through payer determination
- EFT and ERA enrollment for the enrolled payers
- Final status documentation
Enrollment and credentialing decisions are made by the applicable payer or organization and cannot be guaranteed by PriorDesk. State licensing, DEA tracking, hospital and ASC privileging, and multi-state licensing projects are scoped separately.
Custom-scoped services
Some services vary too much by practice, payer environment, and volume to carry a published monthly price. These are scoped and priced in writing after review of the work involved.
Medication Access & Pharmacy Benefits
Pharmacy-benefit prior authorization, exceptions, benefits investigation, and hub and assistance-program enrollment, scoped to the medication mix and volume.
Referral Management
Referral requirement determination, tracking, and renewal, usually scoped alongside eligibility or authorization work.
Payer Contracting & Network Administration
Participation requests, contract administration, fee-schedule review, and negotiation support.
Payer recovery projects
Underpayment recovery follow-up, recoupment response, and aged accounts-receivable clean-up beyond routine claim follow-up.
Credentialing, enrollment, licensing, and privileging projects
Onboarding groups of providers or new locations, state and multi-state licensing, DEA renewal tracking, and hospital or ASC privileging administration.
Higher volume
Practices with payer volume above the published plans can request a custom monthly scope based on service mix, expected volume, workflow complexity, and payer requirements.
What every PriorDesk engagement includes
- A written scope: Responsibilities, included services, capacity, and pricing are documented before work begins.
- U.S.-based support: Contracted work is performed by personnel located in the United States.
- Practice-controlled access: Work is completed through accounts and permissions provisioned and controlled by the practice.
- Documented activity: Actions, reference numbers, requirements, and outcomes are recorded in the practice’s authorized system.
- Clear service boundaries: Clinical, prescribing, and coding decisions remain with the practice and its licensed clinicians.
Pricing FAQ
Do unused cases roll over?
No. Monthly case and verification allowances reset each billing period and unused volume does not roll over.
What happens if we exceed our monthly volume?
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.
Can we purchase only one service?
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.
Can we combine services?
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.
Are all eight service lines included in a Payer Desk plan?
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.
How is work structured when it does not fit a monthly plan?
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.
How are medication access, referral management, and payer contracting priced?
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.
Are appeals included in Payer Desk plans?
No. Formal denial and appeal work is priced separately because the administrative workload can vary significantly by case.
Is credentialing included in Payer Desk plans?
No. Credentialing & Payer Enrollment is a separately priced service.
Does PriorDesk provide medical billing?
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.
Do you guarantee approvals or payment?
No. Authorization, appeal, enrollment, credentialing, contracting, and payment decisions are made by the applicable payer or organization.
Do we have to hire or manage an PriorDesk employee?
No. Practices engage PriorDesk for a defined managed service. PriorDesk is responsible for resourcing and managing delivery of the contracted workflow.
Tell us what is sitting on your team’s desk.
Share the payer work your organization is handling now and the approximate monthly volume. We will help you identify the PriorDesk service level that fits the workload.
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