Prior Authorization & Referral Management

Don't risk your revenue on unapproved procedures. We handle the complex clinical paperwork and insurance follow-ups required to secure authorizations before the patient arrives.

Clinical Abstracting

Our team reviews clinical notes to ensure "Medical Necessity" is clearly documented for payers, reducing the risk of administrative denials.

Real-time Tracking

We monitor pending authorizations daily. If a payer is slow, we escalate the request to ensure your surgical schedule stays on track.

Retro-Authorizations

In emergency cases, we specialize in securing retro-active authorizations to ensure your practice gets paid for urgent care provided.

The PRORCM LLC Authorization Loop

1. Requirement Check

We verify if a procedure needs an auth based on the specific insurance plan rules.

2. Submission

We submit the clinical records and CPT codes via payer portals or fax immediately.

3. Verification

Once approved, we cross-check the auth number against the scheduled claim for 100% accuracy.