Oct 14, 2026
Oct 14, 2026
Best DME Billing Software for Providers in 2026
- Medical Billing
- OneMed Billing
Overview
What prior authorization means for your practice
Prior authorization is the payer’s green light before certain services are provided. For a set of procedures, imaging studies, and medications, the insurer wants to approve the plan before the care happens.
Prior authorization is one of the most common causes of delay. When approval is in place, care moves forward and billing stays clean. When it is missing, incomplete, or late, the claim is often denied and the appointment may need to be cancelled and rescheduled weeks later.
Authorization in place
care proceeds · claim pays clean
Missing, incomplete or late
visit cancelled · claim denied
The care can be appropriate, the patient can be ready, and the outcome can still depend entirely on whether the paperwork was approved.
THE CLOCK NOBODY IS WATCHING
Approved eventually isn’t approved in time.
Prior authorization is the front-end step with the clearest deadline. The appointment is scheduled, the patient has taken time off, and the request may still be sitting in a payer queue without follow-up. If approval comes after the appointment date, the visit is still lost.
One authorization, submitted and left alone
MON
request submitted
TUE
appointment — cancelled
no approval on file
WED
still in payer queue
THU
APPROVED
two days too late
Three days can pass with no payer follow-up at all.
An authorization that lands after the appointment is a denial with extra steps.
That is why we follow up on every request daily and escalate the ones that stall before the appointment date arrives.
Illustrative of a common authorization delay pattern. Turnaround requirements and payer response times vary by plan, service, and urgency.
WATCH-OUTS
Where authorizations stall
Most approval delays come from small breakdowns that compound. These are the ones we are built to catch.
Missing or incomplete documentation
Requests are often delayed because they are submitted without the physician note, imaging report, or prior treatment documentation the payer requires. The payer then asks for more information, and the process loses more time.
Incorrect or outdated codes
A procedure or diagnosis code that no longer matches the payer’s policy turns an appropriate request into a rejected one.
Payer rule changes nobody noticed
Policies shift quietly. A service that needed no authorization last quarter may need one now, and the first sign is a denial.
Submitted, then left alone
A request with no follow-up simply waits. Payer queues do not prioritize themselves, and silence is not the same as progress.
Hours lost on payer phone lines
Front-desk staff cannot hold for forty minutes between patients, so follow-up slips to tomorrow, then next week.
Portals that show no status
Some portals never move past received, so without a call there is no way to know whether anything is actually happening.
WHAT'S INCLUDED
What our prior authorization service includes
We handle the process end to end, so nothing slips: get approvals done right, keep care moving, avoid rework later.
Requirement checks by payer
Whether an authorization is needed at all is confirmed in advance, based on the procedure, diagnosis, and that payer's policy guidelines.
Coded, payer-specific submissions
Requests are prepared to match procedure codes, payer rules, and medical necessity criteria, so they are not rejected on format or detail.
Clinical documentation coordination
Physician notes, test results, and supporting records are gathered, reviewed, and organized to meet what the payer actually asks for.
Portal and phone follow-ups
Active follow-up through payer portals and direct calls, so requests do not quietly stall in a queue.
Status tracking and escalation
Every request is tracked, and urgent or stalled cases are escalated rather than left to wait their turn.
Decision and next-step reporting
We send clear outcomes back to your team, including approval details and reference numbers or the denial reason and our recommended next steps.
HOW IT WORKS
From request received to decision reported
A structured workflow that reduces denials, speeds approvals, and keeps your schedule on track.
Request received
We take the order and procedure details and confirm the payer and patient information.
1
2
Requirements verified
We confirm exactly what the payer requires for the procedure, diagnosis, and policy involved, including whether prior authorization is needed in the first place.
Documentation and submission
We gather the clinical documentation and submit through the payer’s portal, fax, or electronic channel.
3
4
Follow-ups and escalations
We track status daily, call payers, and escalate urgent or delayed requests before they affect the schedule.
Decision and reporting
We report the result to your team with approval details and reference numbers or the denial reason and recommended next steps.
5
APPROVAL TURNAROUND TIME
Before
3 to 5 days
With OneMed
1 to 2 days
These are representative timelines. Actual payer response times vary by plan and service.
What you get
Why practices hand authorizations to OneMed
- Faster approvals, because someone works the queue every day instead of when time allows
- Fewer denials tied to missing or incomplete authorization
- Status tracking and follow-ups you can see, without chasing anyone
- Clinical documentation gathered and organized to meet payer expectations
- Reference IDs and outcome reporting on every request, approved or not
- Fewer cancellations and reschedules caused by approvals that arrive late
Who We Serve
Built for authorization-heavy practices.
High-volume practices
A steady stream of procedures, imaging studies, or medication requests that all need authorization before they can proceed.
Specialty clinics
Settings where most services require approval, and a delay immediately shows up in the schedule and in patient access.
Practices with PA backlogs
Teams already carrying pending authorizations, delayed approvals, and repeated rescheduling from stalled requests.
BY SPECIALTY
Authorization support tuned to your specialty
Authorization demands vary widely by specialty. Support is aligned to those differences rather than run as one generic queue.
Urgent care
Fast-moving schedules need quick checks and rapid follow-up so same-day visits and treatments do not stall.
Laboratory services
Test-specific requirements and frequency limits reviewed to prevent rejections tied to medical necessity or payer policy.
DME and O&P
Detailed documentation, physician orders, and proof of need coordinated to meet strict payer guidelines and avoid repeat submissions.
Telehealth
Coverage rules and place-of-service requirements verified so virtual visits are approved and reimbursed.
OB-GYN
Preventive services, procedures, and imaging authorizations managed to keep care timelines uninterrupted.
Psychiatry
Visit limits, prior approvals, and ongoing authorization renewals tracked to support continuity of care.
Dermatology
Procedure and medication approvals handled with close attention to payer criteria and diagnosis pairing.
Cardiology
Complex, high-cost procedures needing precise submissions, clinical documentation, and active follow-up to secure timely approval.
WHY ONEMED
OneMed versus keeping it at the front desk
The difference is rarely capability. It is whether anyone has the hours to chase a payer for the third time this week.
| Capability | Your front-desk staff | OneMed Billing |
|---|---|---|
| Manual payer follow-up | Often delayed by front-desk workload | Dedicated team working portals and phone queues daily |
| Gap exception handling | Often missed until care is affected | Identified early, with payer-specific escalation |
| Peer-to-peer support | Limited time and experience | Scheduling and documentation prep coordinated |
| Status tracking & daily reports | Manual, limited visibility | Centralized tracking with regular status updates |
| Specialty drug experience | Varies; frequent rework | Familiar with specialty drug and payer requirements |
Fewer delays, fewer denials, and a smoother path from scheduling to treatment.
RESULTS
Measured improvements before and after OneMed
| Metric | Before OneMed | After OneMed |
|---|---|---|
| Approval turnaround time | 3 to 5 days | 1 to 2 days |
| Denials due to missing authorization | 14% | Less than 3% |
| Patient cancellations due to delay | Frequent | Rare |
“Over the past year, prior authorizations went from being a daily frustration to a process we no longer worry about. Approvals have become faster, and denials have become rare.”— Practice Manager, Neurology Group
Representative results across onboarded practices. Actual outcomes vary by specialty, payer mix, and baseline.
DOWNSTREAM
What clean authorization does to the rest of the cycle
Handled properly, authorization quietly supports the visit long before the patient arrives.
Clean claims
Approvals completed in advance align services with payer rules, so claims carry the right authorization numbers and avoid medical necessity rejections.
Faster scheduling
With approval secured early, appointments are booked with confidence instead of waiting on a last-minute payer decision.
Fewer cancellations
Patients are less likely to cancel when coverage is confirmed upfront, with no surprise denial or unexpected cost at check-in.
Better cash flow
Approved services bill faster and pay faster, and staff spend less time on appeals and rework.
Compliance
Your clinical data, handled properly
Prior authorization work involves extensive protected health information. Securing approval requires handling physician notes, test results, imaging reports, and insurance details, not just codes and amounts.
Because of that, we execute a Business Associate Agreement before any protected health information is shared. Work happens on secure systems with controlled access and approved communication methods, and records are handled under HIPAA throughout the request.
Start a referral process reviewBAA signed first
before any records are shared
secure systems · controlled accessNotes, imaging and results — treated as PHI, because they are.
Get started
Book a free authorization audit
Tell us a little about your practice and we’ll show you where authorizations are stalling — and what it would take to get decisions back before the appointment date.
- No-obligation review of your current authorization workflow
- HIPAA-compliant, dedicated coordinators assigned to your practice
- Medical and pharmacy authorizations, across all payer types
Prefer to talk now?
(315) 366-8242
Schedule a 15-minutes call
Our team will review your request and respond within one
business day. Your information will be kept confidential
and used only to address your inquiry.
Request received.
Thank you. A member of our team will review your information and be in touch within one business day. We look forward to showing you what your practice should be collecting.
Frequently Asked
Common questions.
Is your team HIPAA compliant?
Absolutely. All team members are trained in HIPAA and follow strict privacy protocols.
Do you handle both medical and pharmacy authorizations?
Yes, we support both types of prior authorizations across all payer types.
How fast do you submit requests?
We typically submit within 24 hours of receiving the order. Urgent cases are handled same day.
What specialties do you support?
We work with providers in radiology, behavioral health, pain management, neurology, cardiology, and more.
Can you help with peer-to-peer coordination?
Yes. We assist with scheduling and documentation for peer-to-peer reviews when required.
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