Prior Authorization
The problem
Prior authorization is where revenue quietly disappears. A procedure gets scheduled, the authorization is delayed or forgotten, and the claim is denied for no-auth — a denial that is almost impossible to overturn after the fact. The administrative burden is enormous, the payer rules change constantly, and a single missed authorization can cost thousands of dollars that will never be recovered.
How NuGenera Health does it
We own the authorization from requirement identification through approval. When eligibility flags a service that needs prior authorization, we determine the exact payer requirements, assemble the clinical documentation, submit through the payer's preferred channel, and track the request to a decision — not just to submission.
Every open authorization is monitored against its expected turnaround. If a payer is slow, we escalate. If additional clinical information is requested, we route it to the right person immediately rather than letting the request stall. Approvals, denials, and pended requests are all visible so your clinical team knows exactly what is cleared to proceed.
For denied authorizations, we manage peer-to-peer scheduling and appeal submission, because an authorization denial overturned before the service is far cheaper than a claim denial fought after it.
Key capabilities
- Payer-specific authorization requirement determination
- Clinical documentation assembly and submission
- Active tracking to approval with turnaround monitoring
- Escalation of stalled or pended requests
- Peer-to-peer scheduling and authorization appeals
- Auth status visibility tied to your scheduling workflow
Technology that supports it
We work inside your EHR and payer portals, using automation to check authorization requirements and monitor status where payers support it, and structured worklists to make sure no open request goes untouched. Denial-pattern detection surfaces which services and payers most often require authorization, so requests are initiated earlier.
Frequently asked questions
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