Simplify Authorization Workflows. Reduce Delays. Support Timely Patient Care.
TrueCareCost Healthcare Services provides prior authorization and precertification support to healthcare providers, medical practices and healthcare organizations across the United States. Our services focus on identifying authorization requirements, coordinating documentation, preparing and tracking requests, and following up with insurance payers regarding authorization status.
Many health plans require prior authorization or precertification before certain medical services, procedures, diagnostic tests or medications are provided. Managing these requirements can involve multiple steps, supporting documentation and payer-specific procedures. Our structured approach helps practices organize authorization workflows and identify outstanding requirements before scheduled services.
Why Prior Authorization and Precertification Matter
What They Are
Prior authorization is a process through which a health plan reviews a proposed service, procedure or medication to determine whether it meets the plan's applicable coverage criteria. Precertification is a related term used by some payers for advance review of planned healthcare services.
What Happens When They Are Missed
When required authorization is missing, incomplete or not obtained within the required timeframe, healthcare organizations may face service delays, additional administrative work or claim payment issues, depending on the payer's rules and circumstances. An organized process helps practices identify requirements early, coordinate supporting information and monitor payer decisions.
Key Benefits of Prior Authorization Services
Early Requirement Identification
Help identify services that may require authorization before treatment or procedures.
Organized Documentation
Coordinate the clinical and administrative information required for authorization requests.
Application Tracking
Monitor submitted requests and available authorization status information.
Timely Payer Follow-Up
Follow up on pending requests and identify outstanding requirements.
Reduced Administrative Burden
Help practice teams manage authorization-related tasks through structured workflows.
Improved Operational Coordination
Support communication between administrative teams, providers and relevant payer contacts.
Our Prior Authorization and Precertification Services Include
| Service | What It Covers |
|---|---|
| Authorization Requirement Verification | Help determine whether prior authorization or precertification may be required for a planned service, based on available payer information and the practice's established procedures. |
| Authorization Request Preparation | Coordinate the information and documentation required to prepare authorization requests according to applicable payer requirements. |
| Clinical Documentation Coordination | Help organize supporting clinical documentation, such as relevant medical records, diagnostic information and treatment details, as requested by the payer. |
| Authorization Submission Support | Support the submission of authorization requests through designated payer portals or other approved channels, where included in the agreed service scope. |
| Authorization Status Tracking | Monitor available request status information and identify pending requests or outstanding documentation requirements. |
| Payer Follow-Up | Coordinate follow-up with insurance payers to clarify request status, obtain updates and determine whether additional information is needed. |
| Authorization Approval Documentation | Record available authorization details, including reference numbers, approved services and validity periods, where applicable. |
| Authorization Denial and Additional Information Coordination | Help identify the reasons provided for an authorization denial or request for further information and coordinate appropriate next steps with the healthcare organization. |
Our Prior Authorization Process
Identify the Planned Service
Review available appointment, procedure, test or medication information to understand the authorization requirements.
Verify Payer Requirements
Check available payer guidance and identify the applicable authorization process and documentation requirements.
Collect Supporting Information
Coordinate the clinical and administrative documentation needed for the request.
Prepare and Submit the Request
Support preparation and submission through the designated payer channel, where included in the service scope.
Track Authorization Status
Monitor available status information and identify pending requests or additional requirements.
Follow Up with the Payer
Coordinate follow-up on outstanding requests and communicate requests for clarification or additional documentation to the appropriate practice team.
Record the Outcome
Document the available authorization decision, reference details and applicable dates for use by the practice's administrative and billing teams.
Common Prior Authorization Challenges We Help Address
Unclear Payer Requirements
Different health plans may have different authorization rules for specific services, providers and settings.
Incomplete Documentation
Missing clinical information or supporting records may delay the review process or lead to requests for additional information.
Pending Authorization Requests
Requests may remain under review and require status checks or further documentation.
Time-Sensitive Procedures
Scheduled services may require authorization to be obtained within specific timeframes.
Authorization Denials
A payer may decline a request based on its applicable criteria, requiring the practice to review the decision and determine appropriate next steps.
Authorization Record Management
Practices need to maintain accurate records of authorization reference numbers, approved services and applicable validity periods.
Why Choose TrueCareCost Healthcare Services?
Authorization support built around structured workflows, documentation coordination and proactive status monitoring.
Structured Authorization Workflows: Organized processes for requirement checks, documentation coordination, submission support and status tracking. Documentation Coordination: Support for collecting and organizing information requested by the applicable payer. Proactive Status Monitoring: Follow-up workflows to help identify pending requests and outstanding requirements. Clear Authorization Records: Organized tracking of available authorization details and payer responses. Flexible Operational Support: Authorization assistance can be discussed for ongoing requirements, high-volume workflows or defined projects. Integrated Revenue Cycle Support: Prior authorization services can complement eligibility verification, appointment scheduling, medical billing, claim submission and denial management.
Streamline Your Authorization Workflow with TrueCareCost
Managing prior authorization and precertification requirements takes coordination, documentation and timely follow-up. TrueCareCost Healthcare Services helps healthcare organizations organize authorization requests, monitor progress and coordinate payer communication through structured workflows.