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Prior authorization is the payer approval required before certain procedures, medications, imaging studies, and services can be delivered and reimbursed. Prior authorization services manage this entire process — determining when authorization is needed, gathering and submitting the required clinical documentation, following up with payers, handling denials and appeals, and tracking every request to resolution before care is delivered.
Prior authorization is one of the heaviest administrative burdens in healthcare. Physicians and their staff spend an average of 12–14 hours per week on authorizations, and 94% of physicians report that prior auth delays necessary care. Missed or delayed authorizations lead to denied claims, cancelled procedures, delayed treatment, and frustrated patients and providers alike. The volume and complexity of payer-specific requirements make in-house authorization management a persistent operational drain.
SkyCom's prior authorization outsourcing removes that burden entirely. Our trained authorization specialists manage the full auth lifecycle across every payer type and service category — securing approvals faster, preventing authorization-related denials, and freeing clinical staff to focus on patients instead of paperwork, all with HIPAA-compliant, bilingual teams working directly in your EHR and payer portals.
Authorization burden falls hardest on high-acuity, procedure-heavy, and medication-intensive settings — but every organization dealing with payer authorization requirements benefits from dedicated specialists. SkyCom's medical prior authorization services adapt to each organization's service mix, payer landscape, and clinical workflows.
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The complete authorization lifecycle — requirement determination, request submission with clinical documentation, medical necessity justification, status tracking, payer follow-up, denial management, peer-to-peer coordination, and appeals. We handle authorizations for procedures, surgeries, advanced imaging, specialty medications, DME, and inpatient admissions across all payer types.
Dedicated specialists initiate authorizations early, submit complete requests built to payer approval standards the first time, and follow up persistently instead of letting requests sit in a queue. This eliminates the delays caused by incomplete submissions and lack of follow-up — compressing approval turnaround significantly.
Insurance verification confirms a patient’s coverage and benefits. Prior authorization secures the payer’s specific approval to deliver a covered service. They’re complementary — verification tells you a service is covered and whether auth is required; prior authorization actually obtains that approval. SkyCom offers both as integrated or standalone services.
Yes. We analyze denial reasons, submit additional documentation, coordinate peer-to-peer reviews between your providers and payer medical directors, and manage the full appeals process. We recover authorizations that would otherwise become cancelled procedures and denied claims.
All major payer portals and authorization platforms (Availity, payer-specific portals, CoverMyMeds for medications), plus EHR/PM systems including Epic, Cerner, MEDITECH, athenahealth, eClinicalWorks, and NextGen. Authorization status and documentation are recorded where your clinical and billing teams need them.
HIPAA, PCI DSS, SOC 2 Type II, and ISO 27001 certified. Clinical documentation and PHI in authorization requests are encrypted with AES-256, access is role-based with MFA, BAAs are executed with all clients, and we undergo regular third-party audits. Access is terminated within one hour of staff separation.
4–6 weeks including workflow audit, payer portal and EHR access provisioning, specialist training on your service mix and documentation standards, HIPAA certification, and QA setup. We can begin processing authorizations for scheduled services immediately at go-live.
Faster approval turnaround, authorization-related denials reduced 70–80%, day-of cancellations minimized, higher first-submission approval rates, clinical staff hours returned to patient care, and 50–70% lower authorization costs versus in-house staffing — with measurable improvement typically within the first 90 days.
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