Prior authorization
Approvals in place before treatment begins
Insurers use prior authorization (also called pre-certification or prior approval) to decide whether a service, procedure or medication is covered and whether it will be paid in part or in full. Missing or late authorizations delay care for patients and lead to denied claims for providers.
The right diagnosis and the correct medical codes are critical to a timely approval. MTS pre-authorization representatives are trained on up-to-date payer requirements, so requests are complete, accurate and submitted promptly.
What’s included
End-to-end prior authorization management
Requirement checks
We confirm whether each service needs authorization under the patient’s specific plan.
Accurate coding
CPT and ICD-10 codes that match the documented medical necessity.
Complete submissions
Clinical documentation gathered and submitted through the payer’s preferred channel.
Status follow-up
Pending requests tracked and chased so nothing stalls.
Expiry tracking
Authorization dates and visit limits monitored to avoid lapses mid-treatment.
Clear communication
Your team knows the status of every request before the appointment.
How we work
How we secure authorizations
A structured process keeps every request moving and every approval on file.
Identify
Services requiring authorization flagged from your schedule and orders.
Prepare
Codes and supporting documentation checked for completeness.
Submit
Requests filed with the payer via portal, fax or phone.
Follow up
Status tracked to approval and recorded in your system.
The impact on your practice
- Fewer denials for missing authorization
- Treatment scheduled with confidence
- Hours of phone and portal time saved each week
- Better patient experience with fewer delays
FAQ
Common questions
Which payers do you work with?
We handle authorizations for commercial payers, Medicare Advantage and Medicaid plans. Requirements differ by payer and plan, and our team keeps up to date with those changes.
What if an authorization is denied?
We review the reason, correct or supplement the documentation where possible, and support peer-to-peer or appeal steps with your providers.
Can you handle retro-authorizations?
Where a payer allows retroactive authorization, we will pursue it. Contact us to discuss your specific situation.
Related services
Complete the rest of your revenue cycle
Eligibility verification
Confirm coverage and patient responsibility before the visit.