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Prior Authorization Management

Insurance Authorizations Secured Before the Procedure, Not After the Denial

A denied prior authorization does not just delay reimbursement. It delays or cancels the patient's procedure entirely. MBC manages the full authorization lifecycle across Medicare, Medicaid, and commercial payers so your clinical schedule runs without administrative interference.

Start Authorization Review 888-357-3226
MBC Authorization Performance
98.4%
First-Pass Claim Approval Rate
48 hrs
Standard Auth Submission Turnaround
32+
Specialty Types Covered
25+
Years in Revenue Cycle Management
$2.7B+
Annual Claims Processed Across All States

Why Prior Authorization Failures Hurt More Than Your Reimbursement Rate

Authorization denials do not sit quietly in accounts receivable. They block procedures, delay patient care, and consume staff hours in rework that should never have been necessary in the first place.

Procedures Performed Without Authorization Cannot Be Appealed

When a service requiring prior authorization is rendered without one, the resulting claim denial is typically non-appealable. The clinical work is complete, the cost is incurred, and the revenue is permanently uncaptured. No amount of documentation can reverse a structural authorization gap.

Authorization Requirements Change by Payer, Plan, and Procedure

What required prior authorization last quarter may not this quarter, and vice versa. Requirements vary by payer, by specific plan within that payer, and by procedure code. Practices that rely on institutional memory rather than active payer monitoring accumulate authorization gaps they do not detect until denials arrive.

Staff Burden From Authorization Tracking Reduces Clinical Focus

Authorization management is a full-time administrative function when done correctly. Practices that assign it to clinical or front-desk staff as a secondary responsibility consistently see authorization errors, missed follow-up windows, and expired approvals that could not be acted on in time.

Peer-to-Peer Reviews Without Preparation Are Lost by Default

When a payer denies a prior authorization and offers a peer-to-peer review opportunity, practices that enter that review without clinical documentation preparation and payer-specific appeal framing lose the review in the majority of cases. Preparation determines outcome, not clinical merit alone.

How It Works

Authorization Process and Payer Coverage

MBC manages the complete prior authorization lifecycle: submission, follow-up, peer-to-peer review preparation, and appeal coordination across all major payer categories.

01

Clinical Information Gathering and Documentation Review

MBC collects the patient's diagnosis, planned procedure codes, clinical history, and referring physician documentation required to support the authorization request. Incomplete submissions are the leading cause of initial auth denials. We resolve those gaps before the request is submitted.

02

Payer-Specific Submission and Requirement Matching

Authorization requests are submitted through each payer's required channel, with procedure-specific clinical criteria matched to payer medical policies. We identify whether the payer requires online portal submission, fax, or direct phone authorization and route accordingly.

03

Active Follow-Up and Status Tracking

Every submitted authorization request is tracked against the payer's standard processing window. MBC follows up proactively before deadlines, preventing authorizations from expiring in payer queues without your team's awareness. Approval and denial statuses are communicated to your office immediately.

04

Denial Response: Peer-to-Peer and Appeal Coordination

When a prior authorization is denied, MBC identifies whether the denial is appropriate for peer-to-peer review or formal appeal. We prepare the supporting clinical documentation, coordinate the peer-to-peer scheduling, and submit written appeals with payer-specific medical necessity framing.

Payer Coverage Across All Plan Types

MBC obtains prior authorizations across all major federal and commercial payer categories. Services handled per payer type are indicated below.

Medicare (Traditional and Advantage)
Prior Auth Peer-to-Peer Appeals
Medicaid (Federal and State Plans)
Prior Auth Peer-to-Peer Appeals
UnitedHealthcare
Prior Auth Peer-to-Peer Appeals
Aetna
Prior Auth Peer-to-Peer Appeals
Humana
Prior Auth Peer-to-Peer Appeals
Cigna
Prior Auth Peer-to-Peer Appeals
Blue Cross Blue Shield Plans
Prior Auth Peer-to-Peer Appeals
Kaiser Foundation Plans
Prior Auth Appeals
Managed Care and Regional Plans
Prior Auth Appeals
Prior Authorization
Peer-to-Peer Review
Formal Appeals
Provider Group Results

What Provider Groups Report After MBC Takes Over Authorization Management

"We were losing approximately three to four procedures per week to authorization denials because our staff was not tracking expiration dates. MBC took over authorization management and within 60 days our auth-related denials dropped to near zero. The revenue recovery in the first quarter alone exceeded our annual cost for the service."

DW
D. Wallace
Practice Administrator, Orthopedic Surgery Group, Ohio

"Our ASC performs high-volume elective procedures across multiple payers. Every authorization miss was a rescheduled case and a dissatisfied patient. MBC manages every authorization before the case is scheduled and flags potential issues before they become denials. Our case cancellation rate dropped by 74%."

LC
L. Chen
Director of Operations, Ambulatory Surgical Center, California

"We had a batch of Humana peer-to-peer reviews that our physicians were handling without preparation. We were losing nearly all of them. MBC now prepares the clinical documentation package before each review. Our peer-to-peer overturn rate went from under 20% to over 65% in two quarters."

MB
M. Bhatt
CFO, Multi-Specialty Physician Group, Texas
Common Questions

Insurance Authorizations: Frequently Asked Questions

What is prior authorization and which procedures require it?
Prior authorization is a payer requirement that certain procedures, diagnostic tests, specialist referrals, or medications receive explicit approval from the insurance carrier before they are performed. Which services require authorization varies by payer, by the specific plan within that payer, and by procedure code. Common categories include elective surgical procedures, advanced imaging, specialty drug infusions, durable medical equipment, and inpatient admissions. Requirements change frequently, which is why active payer policy monitoring is essential to maintaining authorization compliance.
What happens if a procedure is performed without prior authorization?
When a procedure requiring prior authorization is rendered without one, the resulting claim is typically denied as administratively non-covered. Unlike clinical denials, administrative denials for missing authorization are frequently non-appealable, meaning the revenue cannot be recovered through standard denial management channels. The practice absorbs the cost of care rendered without reimbursement. Retrospective authorization requests are occasionally accepted by some payers in extenuating circumstances, but approval is not assured and the process is time-intensive.
How does MBC handle prior authorization denials?
When a prior authorization request is denied, MBC evaluates the denial reason to determine the appropriate response pathway. For denials based on insufficient clinical documentation, MBC prepares and submits additional supporting records. For denials where a peer-to-peer review opportunity exists, MBC coordinates the scheduling and prepares the physician with a structured clinical summary and payer-specific medical necessity framing before the review call. For denials that do not resolve through peer-to-peer review, MBC prepares and submits formal written appeals with complete supporting documentation.
How long does the prior authorization process typically take?
Standard prior authorization processing times vary by payer and urgency level. Routine requests typically receive a decision within 3 to 14 business days depending on the payer. Urgent requests, submitted when a patient's condition requires expedited care, are typically processed within 24 to 72 hours under federal and state regulatory timelines. MBC submits authorization requests as early as the schedule allows and tracks payer-specific processing windows to ensure authorization decisions are received before the scheduled service date.
Does MBC manage authorizations across all specialties and payer types?
MBC manages prior authorization requests across 32+ specialty types including orthopedics, ASC procedures, dermatology, wound care, OB-GYN, family practice, and others. Authorization management is handled across all major payer categories including Medicare, Medicare Advantage, Medicaid, managed Medicaid, and commercial payers such as UnitedHealthcare, Aetna, Humana, Cigna, Blue Cross Blue Shield plans, and regional managed care organizations. Authorization services are available both as a standalone offering and as part of MBC's full revenue cycle management suite.
Related RCM Services

Authorization Management is One Part of a Complete Revenue Cycle

Patient Enrollment Insurance Verification Medical Billing Medical Coding Physician Credentialing Denial Management AR Follow-Up Billing Outsourcing

Ready to Close Your Authorization Gaps?

MBC manages prior auth submissions, follow-up, peer-to-peer review preparation, and appeals across all major payer types. Speak with a revenue cycle specialist about your practice's authorization requirements.

Start Authorization Review 888-357-3226
Serving Provider Groups in Your State
Authorization management services available across all states.
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