Simplify Prior Authorization. Safeguard Reimbursements

SolvEdge streamlines prior authorizations by ensuring medical necessity, meeting payer requirements, and accelerating approvals—reducing administrative burden and protecting your revenue.

  • ✓ Reduce Denials
  • ✓ Accelerate Approvals
  • ✓ Protect Revenue
SolvEdge prior authorization multi-channel submission process

SolvEdge’s End-to-End Authorization Management Approach

SolvEdge’s End-to-End Authorization Management Approach

Multi-Channel Submission

Requests are submitted via payer-preferred platforms—phone, web portal, or fax—based on standardized protocols. Our team adheres to payer-specific documentation requirements to minimize rework and reduce delays.

Standardized Authorization Checklist

We employ a pre-verified documentation checklist customized by payer, ensuring submission accuracy. This includes demographic, clinical, and procedural data such as CPT/HCPCS codes, diagnosis codes (ICD-10), provider/facility information, and relevant clinical narratives.

Real-Time Communication & Follow-Up

Ongoing follow-up with payers ensures that pending authorizations are resolved promptly. We track turnaround times and escalate issues proactively to prevent workflow disruptions.

Cross-Specialty Expertise

Our team understands the nuances of authorizations for high-cost services such as diagnostic imaging, surgeries, infusion therapy, and inpatient admissions—ensuring precise handling across multiple specialties and service lines.

Navigating Approvals: The Prior Authorization Services Journey

1

Initial Request

  • Need & Eligibility: Doctor orders service; PA team checks if insurance requires pre-approval and if patient is covered.
  • Gather & Submit Info: Collects patient records, fills forms, and sends them to the insurer.
  • Track & Decide: Follows up for approval or denial; if denied, moves to appeals.
2

Appeals

  • Denial Review & Justify: Analyzes denial reason and gathers more clinical proof for the service.
  • Submit Appeal: Sends formal appeal to insurer; may include doctor-to-doctor discussion.
  • Outcome: If denied again, considers external review.
3

Retroactive Authorization

  • Service Done, No PA: For emergencies or missed PAs, team justifies why pre-approval wasn't possible.
  • Submit & Follow-up: Requests approval for already-rendered service; insurer reviews retrospectively.
4

Medically Not Necessary Cases

  • Specific Denial: When insurer says service isn't needed.
  • Prove Medical Need: Team works with doctor to provide strong clinical evidence and arguments, often via doctor-to-doctor talks, to overturn the denial.

Strategic Advantages for Healthcare Providers

SolvEdge prior authorization multi-channel submission process
Team Discussion

Improved First-Pass Authorization Rates

Meticulous documentation and process rigor reduce incomplete submissions and approval delays.

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Faster Reimbursement Cycles

Validated authorizations facilitate cleaner claims, contributing to quicker revenue realization and reduced AR aging.

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Lower Administrative Overhead

By offloading authorization management to SolvEdge, internal resources can focus on clinical and operational priorities.

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Reduced Denial Risk

Proactive verification and documentation alignment mitigates denials due to authorization issues, decreasing appeals workload.

Proven Benefits for Your Practice

Improved Cash Flow

By promptly posting insurance and patient payments, we help reduce days in AR and ensure timely revenue recognition.

Financial Transparency

Accurate reconciliation gives you a clear picture of your practice’s financial health. Eliminate AR confusion caused by delayed check deposits or missed ERAs.

Customized Workflows

Our payment posting process is adapted to your unique financial protocols and system preferences, ensuring smoother operations and better outcomes.

Reduced Administrative Burden

Free your staff from time-consuming posting tasks and allow them to focus on patient care and higher-value activities.

What Sets SolvEdge
Apart?

SolvEdge prior authorization multi-channel submission process
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Reduce Denials and Protect Your Revenue

Let SolvEdge handle the administrative complexity of prior authorizations—so your team can focus on delivering patient care, not chasing approvals.

FAQ – SolvEdge Prior Authorization

Prior authorization typically takes 3-15 business days, depending on the payer and case complexity.
Urgent cases may be expedited, often within 24-72 hours.

Denials occur due to incomplete documentation, non-covered services, or lack of medical necessity.
Errors in coding or mismatched patient information can also lead to rejection.

Review denial reasons, gather missing information, and submit an appeal or resubmit promptly.
Contact the payer for clarification if the denial reason is unclear.

No, prior authorization ensures medical necessity but doesn’t guarantee payment; other factors apply.
Eligibility, policy coverage, and claim accuracy still impact reimbursement.

Insufficient documentation, services not medically necessary, and non-compliance with payer policies.
Late submission or incorrect procedure codes are also common causes.

Submit a formal appeal with additional documentation and justification within the payer’s deadline.
Include a detailed letter explaining the medical necessity of the service.

Yes, if the patient was informed of non-coverage and agreed to pay out-of-pocket beforehand.
Written consent, like an Advance Beneficiary Notice, is often required.

Ensure complete documentation, verify payer requirements, and use electronic submission tools.
Training staff on payer-specific protocols can streamline the process.

The healthcare provider or their staff is typically responsible, though patients may assist.
Clear communication between provider and patient ensures timely submission.

Submit accurate, complete documentation and stay updated on payer policies and guidelines.
Regular audits and staff training can minimize errors and denials.