Simplifying Complex Authorizations, Reducing Denials
Clinical Prior
Authorization Services
Secure clinical authorizations for complex medical cases efficiently, minimizing claim denials and accelerating patient care.
Overview
Clinical authorization is a critical requirement from health insurance companies to verify the medical necessity of procedures and treatments.
Healthcare organizations face significant administrative and clinical challenges in obtaining prior authorizations from payers for both inpatient and outpatient services.
Healthcare organizations face significant administrative and clinical challenges in obtaining prior authorizations from payers for both inpatient and outpatient services.
We support you in securing clinical authorizations for complex medical cases, covering both prior (prospective) and concurrent authorizations. Our approach ensures proper reimbursement and timely care delivery aligned with payer contracts.
A key element of the process is accurately sharing clinical information to demonstrate medical necessity, which is essential for minimizing claim denials and avoiding delays in patient care.
Services Provided
Health provides experienced, knowledgeable resources to manage and streamline clinical authorizations, helping healthcare organizations reduce administrative burden and improve approval timelines.
Our clinical prior authorization services include:
-
Eliminating backlogs of pending authorizations to accelerate care delivery
-
Monitoring communication between providers and payers for timely updates and responses
-
Managing concurrent authorizations to support inpatient care continuity
-
Providing accurate medical coding to support claims and medical necessity
-
Handling faxing services for documentation submission and follow-up
-
Coordinating peer-to-peer reviews to resolve complex or denied cases efficiently
With a deep understanding of payer requirements and clinical protocols, our team helps ensure timely, accurate authorizations—supporting both financial performance and patient outcomes.
Benefits
Proper Reimbursement
Achieving proper reimbursement is critical to sustaining financial health and operational efficiency in today’s complex healthcare environment. We help ensure your organization receives accurate, timely payments by aligning clinical documentation, coding, and authorization processes with payer requirements.
Mitigate Denials
Preventing denials starts with precision at every step of the care and billing process. We help healthcare organizations proactively identify and resolve the root causes of claim denials—protecting revenue and improving reimbursement outcomes.
Timely Delivery of Care
By accelerating prior and concurrent authorizations, improving communication with payers, and reducing administrative bottlenecks, we enable faster care delivery—aligned with both clinical urgency and payer requirements.
Efficiency, Precision, and Performance with RCM
Clinical Administrative
Services
Outsourced clinical resources to ensure compliance, optimize reimbursement, and enhance patient care.
Clinical Prior Authorization Services
We assist in securing clinical authorizations for complex medical cases, including both prior (prospective) and concurrent authorizations, to ensure appropriate reimbursement and timely care delivery in alignment with payer contracts.
Clinical Integrity Services
Accurate coding depends on meaningful documentation that is complete, precise, and consistent. Implementing a well-designed Clinical Documentation Integrity (CDI) program can help you achieve these standards and enhance revenue outcomes for your organization.
Clinical Denials and Appeals
Healthcare providers face significant challenges managing clinical denials and appeals, which can affect timely and full payment for services rendered. Denials often stem from issues related to medical necessity, clinical validation, length of stay, or level of care, and may occur concurrently (while the patient is still admitted) or retrospectively (after discharge).
Physician Advisory Services
We also facilitate peer-to-peer reviews with insurance companies, enabling direct dialogue between our physicians and insurers’ medical professionals. This collaborative approach fosters transparency, improves communication, and builds mutual understanding of complex cases.
>10%
Eligibility denials reduction
7-10%
Decrease in documentation errors
30%
Average reduction in A/R days
Value-based care
We empower health plans to achieve compliant, accurate, and optimized financial outcomes through tailored risk adjustment and quality improvement strategies. Our solutions support all engagement models—prospective, concurrent, and retrospective—ensuring seamless integration across the care continuum..
Risk management
We deliver integrated risk management and quality improvement strategies that proactively identify potential issues, ensure regulatory compliance, and drive measurable improvements in patient outcomes. Leveraging analytics, evidence-based protocols, and continuous performance monitoring, Reduce variability, close care gaps.
Care Coordination
Our care coordination solutions bridge gaps across the healthcare continuum by facilitating timely, patient-centered interventions. Through integrated workflows, multidisciplinary collaboration, and real-time data sharing, we help health plans and providers manage complex care needs, reduce avoidable utilization
Provider & Member
Our communication strategies foster stronger relationships between payers, providers, and members through timely, personalized, and compliant outreach. Whether educating providers on coding accuracy or guiding members through care pathways and preventive services, we use omnichannel engagement, culturally competent messaging.
Driven by Purpose, Defined by Impact
Who We Serve What We Deliver
Deep domain expertise, and advanced technology—shifting from reactive responses to proactive strategies.
Hospitals & Health Systems
Acute, Inpatient & Outpatient Facilities, Physician Groups, Integrated Delivery Networks
Large Physician Practices
All specialties including Radiology, Urgent Care, Anesthesiology, Dermatology, Endocrinology, Gastroenterology, Geriatric, Emergency...
Independent Physician Groups
All independent groups and specialty clinics including Internal Medicine, Primary Care, General Practice, Pediatrics, Rural Health and FQHC, and Multispecialty.
Contact us with ease
Get in touch
Visit our agency or simply send us an email anytime you want. If you have any questions, please feel free to contact us.
Headquarters
A2O Healthcare
USA Office
10301, Northwest - FWY, STE, 314, Houston, Texas- 77092, USA
Our Locations
Where to find Us?
Delhi Office: 2New Delhi E-92, 1st Floor, South Extension Part-1, New Delhi – 110049, India
Bangalore Office:No 6 4 th Floor Wisdom Heights Kalyan Nagar Bangalore -560043
Singapore Office:1 N Bridge Rd, #46 High Street Centre, Singapore 179094