Essential Service

Prior Authorization Services

Prior authorization is payer approval obtained before a service is delivered. When it is missed, the claim denies after the care has already been provided — the worst possible outcome, since the cost is sunk. Vizora manages authorization requests, follow-up and appeals end to end.

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What’s included

Request initiation — We assemble and submit authorization requests with the clinical documentation each payer requires.
Active follow-up — Requests are pursued rather than filed and forgotten, with escalation when they stall.
Real-time tracking — Every pending request visible with current status and expected decision date.
Criteria expertise — Working knowledge of payer-specific clinical criteria and how to document against them.
Peer-to-peer coordination — We arrange and prepare providers for peer-to-peer reviews when required.
Denial appeals — Authorization denials appealed with strengthened clinical justification.

The problem

Where prior authorization goes wrong

Treatment delayed while authorization sits in a payer queue

Claims denied for missing authorization after care was delivered

Clinical staff pulled off patient care to chase payer approvals

No visibility into which requests are pending or stalled

Payer-specific clinical criteria that change without notice

Authorization denials accepted rather than appealed

How it works

Our prior authorization process

Request initiation

We receive the order, confirm authorization is required, and gather the supporting clinical documentation.

Submission & follow-up

Requests are submitted to the payer and actively worked until a decision is issued.

Status tracking

Real-time status is maintained and communicated proactively to your scheduling team.

Approval or appeal

Approvals are documented in your system; denials are appealed with strengthened justification.

Outcomes

What changes for your practice

We baseline these during the free audit so improvement is measured against your actual starting point, not an industry average.

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Faster approvals and fewer treatment delays
Authorization-related denials substantially reduced
Clinical staff returned to clinical work
Complete visibility into pending requests
Documentation aligned to each payer's criteria
Denied authorizations appealed rather than absorbed

Specialty coverage

Prior Authorization by specialty

Each specialty fails differently. These pages cover the specific codes, denial patterns and payer rules that apply.

Cardiology Orthopedics Mental & Behavioral Health Pain Management Physical Therapy Radiology

Questions

Prior Authorization FAQ

Last updated August 20, 2026

Reviewed by a certified coding lead

Most authorizations are decided within 3–5 business days, though this varies significantly by payer and service. Urgent requests can often be expedited. We track every pending request and escalate anything sitting beyond the payer's stated turnaround.

We appeal. Authorization denials frequently turn on documentation that did not clearly address the payer's clinical criteria rather than on genuine medical necessity. We work with your clinical team to strengthen the justification and resubmit, including arranging peer-to-peer review where that is the faster path.

Yes — major commercial payers, Medicare Advantage plans, and Medicaid managed care organizations. Each maintains its own criteria and submission channels, which is precisely the complexity this service exists to absorb.

Because the service has usually already been delivered. Unlike an eligibility denial caught before the visit, an authorization denial means you have incurred the full cost of care with no path to payment. That asymmetry is why authorization is worth managing proactively.

Terms used on this page

Prior Authorization

Prior authorization is a payer requirement that a service be approved before it is delivered. Without it, the claim is denied regardless of medical necessity, and in most contracts the balance cannot be billed to the patient — the practice absorbs it entirely.

Still deciding how to run billing at all? Compare in-house against outsourced or read the full set of comparisons.

Related services

Eligibility Verification

Real-time coverage checks that stop denials before they are created.

Denial Management

Root-cause analysis, strategic appeals, and prevention that compounds.

Medical Billing & Coding

Complete billing and coding built to maximize reimbursement and reduce denials.

Find out what your denials are costing you

A free billing audit reviews your denial rate, AR aging and clean claim rate against industry benchmarks. Takes about two minutes to request. No sales pitch.