Pre-Authorization
Detect what needs prior authorization, submit and track it automatically, and clear approvals before the visit - so care isn't delayed or denied.
Prior authorization is one of the biggest sources of delayed care and denied claims. MedXFlow flags services that need authorization the moment they're ordered or scheduled, submits the request to the payer with the right documentation, and tracks it to approval - surfacing anything at risk so staff act before the visit, not after the denial.
What's inside Pre-Authorization
- Auto-detect requirements - Payer- and plan-specific rules flag which orders and visits need authorization, up front.
- Submit with documentation - Requests go to the payer with the clinical documentation attached - no chasing forms.
- Live status tracking - Every auth is tracked to approval, with at-risk and expiring authorizations surfaced early.
- Denial prevention - Nothing is delivered un-authorized, so auth-related denials and write-offs drop sharply.
How it works
- Requirement detected - The moment a service is ordered or booked, auth rules flag whether it's needed.
- Request submitted & tracked - MedXFlow files it with documentation and tracks it to a decision.
- Cleared before the visit - Approved authorizations post to the record; at-risk cases are escalated to staff.
What you get
- Care delivered on time, not delayed by paperwork
- Far fewer authorization-related denials and write-offs
- Staff hours saved on portals and payer phone calls
- Every authorization tracked, documented and auditable
Frequently asked questions
What is prior authorization?
Prior authorization (also called pre-authorization or precertification) is a payer's approval that a service is covered before it is delivered. Without it, the claim is usually denied, and those denials are hard to appeal after the fact.
How long does prior authorization take?
It varies widely by payer and service, from same-day to one or two weeks. Automating detection, submission and follow-up shortens the wait by removing the delays that come from incomplete requests and un-chased status.
What is the difference between prior authorization and precertification?
The terms are largely used interchangeably. Both refer to getting a payer's approval before a service; some payers use precertification for inpatient or specific services and prior authorization more broadly.
How do you speed up prior authorization?
Detect what needs an auth the moment it is ordered, submit with the right clinical documentation, and track every request to a decision. MedXFlow's AI agents do this end to end, using the X12 278 where payers support it and payer portals where they do not.
How do you appeal a prior authorization denial?
Submit the payer's appeal with additional clinical documentation supporting medical necessity, within the payer's deadline. Tracking auth requirements up front prevents most of these denials in the first place.