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Prior Authorization Services

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Prior Authorization Services

PRIOR AUTHORIZATION SERVICES

Prior Authorization Services Built Around What Payers Actually Require

Every authorization request goes out with the clinical documentation the payer needs to approve it, and is tracked from submission to decision, so a slow payer queue doesn’t turn into a delayed or canceled procedure.

Credexa Solutions built this service for practices tired of watching authorizations stall. You get a clear status on every request, submitted, pending, approved, or flagged, instead of silence while a scheduled procedure waits.

Get Your Free Prior Authorization Review

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Clean Claim Rate
0 %
Hour Entry Turnaround
12- 0
Payers in Network
0 +
States Served
0
WHAT WE HANDLE

Everything That Happens Between Scheduling a Procedure and Getting It Approved

Prior authorization services from Credexa Solutions cover the full path from the day a procedure is scheduled to the day the payer approves it.

01

Clinical Documentation Assembly

We gather the clinical notes, test results, and medical necessity justification each payer asks for, and check them against that payer’s criteria before anything is submitted.
02

Payer-Specific Requirement Check

Authorization rules differ by payer and plan. We confirm what the specific payer requires for the specific procedure up front, instead of finding out when a claim denies for a missing authorization.

03

Submission and Status Tracking

Each request is submitted and tracked from the moment it is sent, so you always know if it is pending, approved, or needs more information.

04

Turnaround Follow-Up

Requests that sit past a payer’s normal response time get followed up on by us, instead of waiting for the payer to reach out.

05

Appeals

A denied request gets reviewed right away. We find the reason, fix what is missing, and resubmit or appeal, so one denial doesn’t become a canceled procedure.

06

Reporting

You see turnaround time, approval rate, and denial reasons by payer, so you know exactly where requests are getting stuck.
WHY CHOOSE CREDEXA

Why Practices Choose Credexa Solutions for Prior Authorization Services

Credexa handles the parts of prior authorization that decide whether a request is approved, not just the parts that are easy to automate.

01

Documentation Payers Require

Clinical notes, test results, and medical necessity justification are assembled for each payer and checked against that payer’s criteria first.

02

Payer-Specific Requirements

The same procedure can need authorization with one payer and not another. We confirm requirements before the request goes out.

03

A Status on Every Request

Every request carries a clear status, pending, approved, or flagged for more information, tracked from submission through decision.

04

Appeals Without Restarting

A denied request is corrected and resubmitted or appealed, so your staff never starts the prior authorization over from scratch.

HOW PRACTICES ENGAGE CREDEXA

Two Ways to Handle Prior Authorization

No contract either way. Buy it standalone, or get it included with full-service RCM.

Standalone Prior Authorization

Priced by request volume

BEST VALUE

Included Free Inside Full-Service RCM

FREE

Included in your 2.99% rate

Transparent pricing. No hidden fees. No surprises.

WHERE ARE YOU RIGHT NOW

Which of These Describes Your Prior Authorization Process?

Most prior authorization problems stay hidden until a scheduled procedure gets delayed or denied. Select what applies to your practice below.

Select What Applies to Your Practice

Get a Clear Answer on Where Your Requests Stand

A free review looks at how your prior authorization requests are handled today: how they are documented, how long they wait for a decision, and where they get stuck. You’ll see the gaps before you change anything.

WHAT PRACTICES ASK

Questions Practices Ask About Prior Authorization Services

Everything you need to know about prior authorization requirements, timelines, pricing, and what happens after a request is submitted.
What services typically require prior authorization?
It varies by payer and plan, but typically includes high-cost imaging (MRIs, CT scans), specialty medications, non-emergency surgeries, outpatient procedures, and medical equipment. Our team thoroughly validates clinical guidelines for each patient’s specific policy to ensure compliance.
It depends on the payer and clinical urgency. Standard requests usually take between 3 to 14 business days, while urgent or expedited requests can be completed in 24 to 72 hours. Our dedicated specialists submit clean requests rapidly to minimize administrative delays.
We review the denial reason immediately. If it is due to missing documentation or coding mismatches, we compile the necessary clinical notes and submit an appeal. If a peer-to-peer review is required, we prep your provider with all clinical details and talking points.
Standalone prior authorization is priced by request volume, allowing your practice to pay only for what you submit. This is ideal for practices with seasonal spikes or specific high-overhead specialties. Contact us today to receive a customized volume quote tailored to your workflow.
Yes. We work directly inside the EHR system you already use, securing authorizations, uploading documentation, and updating status fields directly. This ensures your local staff maintains full real-time visibility without leaving their native platform.
Requests are submitted in the format each payer requires, fully aligning with the latest CMS electronic prior authorization mandates and HL7 FHIR standards to accelerate digital approvals and ensure perfect regulatory compliance.

Still have questions?

Can’t find the answer you’re looking for? Our specialists can walk you through how prior authorization fits your practice and payer workflow.

Ask a Billing Specialist

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