Services
Prior authorization handled before the patient arrives
We check every scheduled service against payer requirements, submit requests with the right clinical documentation, and track each one to a decision so visits aren't delayed and claims aren't denied.
| Code | What it means |
|---|---|
CARCCO-197 | Precertification or authorization absent |
CARCCO-15 | Authorization number missing, invalid or does not apply |
CARC = claim adjustment reason code, as printed on your remittance.
Prior authorization is time-sensitive work that pulls your staff away from patients. Requirements differ by payer, plan and service, and they change often.
Medwiser’s authorization team checks each scheduled service, submits complete requests and keeps every case moving until it is decided. Your front desk sees the status in your own system.
What's included
- Requirement checksEach scheduled procedure, imaging study, drug or referral checked against the patient's plan and the payer's current authorization list.
- Request submissionRequests submitted through payer portals, fax or phone with the clinical notes, codes and forms each payer asks for.
- Status trackingPending requests followed up until there is an approval, a denial or a request for more information.
- Peer-to-peer coordinationWhen a request is denied, we schedule the peer-to-peer review and prepare the case summary for your provider.
- Authorization recordsApproval numbers, dates and approved units recorded in your system, so the claim matches what was authorized.
Where revenue leaks
The problems we fix
Services performed without an authorization
A missed requirement means a denial that is hard to overturn. We check requirements when the visit is scheduled, not on the day.
CARCCO-197Precertification or authorization absent
Authorization doesn't match the claim
Approved codes, units or dates that differ from what was billed cause denials even when an authorization exists. We match the claim to the approval before submission.
CARCCO-15Authorization number missing, invalid or does not apply
Requests stuck in pending
Requests without a decision delay care. We follow up on a fixed schedule and escalate before the appointment date.
How it works
Getting started with prior authorization
Map your requirements
We list the services you schedule most and the payers that require authorization for them.
Connect to scheduling
We get access to your schedule so new visits are checked as soon as they are booked.
Request and track
Requests go out with clinicals attached, and every pending case is followed up until decided.
Report
Approval rates, turnaround by payer and any authorization-related denials, reviewed with you.
Benchmarks
The numbers we report against
Industry benchmarks and our own service targets. We measure your baseline in a free review and report against it every month.
FAQ
Prior Authorization: common questions
Which services do you handle authorizations for?
Procedures, advanced imaging, specialty drugs, durable medical equipment, therapy visits and referrals, for commercial, Medicare Advantage and Medicaid plans.
How much notice do you need before an appointment?
The more the better. We aim to submit within one business day of the visit being scheduled. For urgent cases we submit as expedited requests.
Do you handle authorizations for practices that do their own billing?
Yes. Prior authorization is available on its own and works with whichever team submits your claims.
What happens if a request is denied?
We tell you the same day, check whether the denial can be fixed with more information, and set up a peer-to-peer review for your provider if needed.
Related services
Often paired with
Denial Management
Denials appealed fast and prevented from happening again.
- Every denial coded to its CARC reason
- Appeals with the right documentation
- Root-cause fixes upstream
Medical Billing & Coding
Accurate codes and clean claims, submitted within one business day of the visit.
- Specialty-trained coders
- Claims scrubbed before submission
- Daily charge entry
Free workflow review
Stop losing visits to missing authorizations
Tell us which services and payers cause the most delays, and we will show you how we would handle them.