Prior authorization services that keep care and revenue moving
Waiting on an authorization delays care, and skipping one means a guaranteed denial. ClaimEdgeSolutions identifies which services need approval, submits complete requests with clinical support and follows up until a decision is made.
Common problems we fix
If any of these are happening in your practice, revenue is slipping away every week.
- Procedures delayed while staff wait on payer decisions
- Denials for services performed without approval
- Expired or exceeded authorizations nobody tracked
- Hours of clinical staff time lost to payer portals and faxes
How ClaimEdgeSolutions handles prior authorization
Requirement checks
Payer-specific rules checked for every ordered service.
Complete submissions
Requests with clinical notes, imaging and medical necessity support.
Follow-up to decision
Status checks until approval, with peer-to-peer scheduling when needed.
Retro-authorizations
Pursued for urgent and emergency services where payers allow.
Expiry tracking
Visit counts and date ranges monitored, with renewals requested on time.
Referral management
Incoming and outgoing referrals logged and linked to authorizations.
Specialists who own your prior authorization
You get named people who learn your providers, payers and workflows, not a rotating queue. Every open item has an owner and a deadline.
- Requirement checks
- Complete submissions
- Follow-up to decision
The metrics we report on
Your monthly report tracks these numbers for this service, alongside your overall revenue cycle KPIs.
Request to decision
Requests approved
Claims denied for missing auth
From audit to results in four steps
Free revenue audit
We review your A/R aging, denial history, payer mix and coding patterns, then show you what is recoverable.
Onboarding
BAA signed, secure system access set up, workflows mapped and your dedicated team assigned.
Daily operations
Claims, payments, denials, A/R and patient billing are worked every business day.
Monthly review
A KPI report and a call with your account manager covering results and next steps.
Often paired with Prior Authorization
Medical Billing & Coding
Certified coders and billers who turn every encounter into a clean, compliant claim.
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Revenue Cycle Management
End-to-end RCM from patient scheduling to the final zero balance.
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Credentialing & Enrollment
Get providers enrolled with payers faster, and keep them active.
Explore serviceAvailable for every specialty, including
Frequently asked questions
Straight answers about how ClaimEdgeSolutions works with your practice.
Ask us anything01Which services do you handle?
Imaging, surgeries, infusions, specialty drugs, DME, therapy visits, behavioral health and more.
02Do you handle peer-to-peer reviews?
We schedule them, prepare the clinical summary and brief your provider.
03How do we send requests to you?
Through your EHR task queue, a shared secure inbox or a simple order form. We fit your workflow.
04Can you handle urgent requests?
Yes. Urgent and expedited requests are prioritized the same day.
05Do you sign a Business Associate Agreement?
Yes. A BAA is signed with every client before we access any protected health information.
See where your revenue is leaking
Get a free, no-obligation revenue audit. We review your A/R, denials and coding patterns and show you exactly what is recoverable.