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Expert Prior
Authorization Services

SwiftCare Billing streamlines the time-consuming process of prior authorizations (PAs) for healthcare providers, reducing delays, preventing denials, and enhancing patient satisfaction. Let our experts handle prior authorizations, allowing your staff to focus on patient care.

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About Our Prior Authorization Services

Prior authorization is the process of obtaining payer approval before providing specific procedures, medications, or services. Without it, claims are denied, and care is delayed.

SwiftCare helps providers:

  • Identify which services require PA
  • Gather clinical documentation
  • Submit requests & follow up
  • Resolve denials & resubmit if needed
  • Our Services

Our Prior Authorization Services

We offer comprehensive prior authorization (PA) solutions designed to help healthcare providers streamline approvals, reduce claim denials, and improve patient care timelines. Below are our core services:

Eligibility Verification & PA Requirement Check

We verify the patient’s insurance coverage and determine whether a prior authorization is required for the planned service, procedure, medication, or device. This step eliminates unnecessary delays and ensures compliance with payer policies.

Clinical Documentation Collection & Review

Our team works with your staff to gather all necessary medical records, progress notes, physician orders, and diagnostic results required to support the PA request. We also review the documentation to ensure it meets the specific criteria of each payer.

Prior Authorization Submission

We complete and submit accurate PA requests to insurance carriers, using the appropriate forms and portals for each payer. Our team ensures that all required codes, supporting documentation, and justifications are included to minimize the risk of rejection.

Follow-up & Status Tracking

We actively follow up with the insurance company to monitor the status of each request. Our team communicates directly with payer representatives to expedite approvals and resolve any pending issues.

Appeals & Denial Management

If a PA is denied, we promptly investigate the reason, gather any necessary additional supporting information, and submit a timely appeal. We handle the entire denial resolution process to secure approvals whenever possible.

Reporting & Transparency

We provide your practice with clear, timely updates and detailed reports on all active and completed PAs. This ensures your team is always informed about the status of requests and patient scheduling.

Training & Workflow Integration

We help practices streamline their internal processes by offering guidance on documentation best practices, payer policies, and integrating PA workflows into their EHR or PM system.

Why Prior Authorization Matters

Over 90% of practices experience care delays due to PAs.

Outsourcing PAs can save your staff 10+ hours/week.

The average PA takes 1–2 business days if managed correctly — significantly longer without expertise.

Challenges Providers Face with Prior Authorizations (PAs)

Prior authorizations are one of the most frustrating administrative burdens for healthcare providers in the U.S. Without an expert process in place, they can drain resources, delay care, and hurt both revenue and patient satisfaction. Here’s what most practices struggle with:
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Complex, Ever-Changing Payer Rules

Every insurance company — from Medicare Advantage to commercial PPOs — has its own unique and evolving policies about what services require prior authorization and what documentation is acceptable. Keeping up can feel impossible without dedicated expertise.

Submitting a single PA often requires multiple phone calls, faxes, and online portals — with staff spending hours waiting on hold or completing redundant forms instead of directly supporting patients.
Many practices don’t have a dedicated PA specialist. Instead, medical assistants or front-desk staff are tasked with managing authorizations, which can lead to mistakes, missed deadlines, and preventable denials.
When PAs are not handled correctly, patients experience frustrating delays in receiving necessary procedures, imaging, medications, or therapies — which can negatively affect their health outcomes and your practice’s reputation.
For both clinicians and staff, the burden of managing prior authorizations contributes to workplace stress and burnout, which is cited by over 88% of physicians as a significant source of frustration.

States We Serve

At SwiftCare Billing, we proudly deliver expert medical billing, coding, credentialing, prior authorization, and revenue cycle management services across all 50 U.S. states. Whether you operate a solo practice in New York, a specialty clinic in Texas, a surgery center in Florida, or a hospital system in California, our team understands both federal and state-specific payer regulations to keep your practice compliant and profitable.We have a strong presence in:
California

Texas

Florida
New York
Illinois
Pennsylvania
New Jersey
Ohio
Georgia
Arizona
Michigan
North Carolina
Virginia
Massachusetts
Maryland
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Expertise Across 50+ Specialties

Our billing and RCM team has deep experience working with over 500 medical and surgical specialties and subspecialties — delivering specialty-specific expertise that reduces denials and improves collections. We understand the nuances of coding, payer policies, and documentation for specialties including (but not limited to):
  • Cardiology, Gastroenterology, Neurology, Nephrology
  • Orthopedics, Pain Management, Dermatology, Urology
  • OB/GYN, Pediatrics, Family Medicine, Internal Medicine
  • Behavioral & Mental Health: Psychiatry, Psychology, Counseling
  • Physical Therapy, Speech Therapy, Occupational Therapy
  • Ambulatory Surgery Centers (ASCs) & Hospitalists
  • Telemedicine & Remote Patient Monitoring (RPM/CCM)
  • And many more niche specialties
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  • Universal Compatibility

EHR & Practice Management (PM) System Integration

At SwiftCare Billing, we work directly within your existing Electronic Health Record (EHR) and Practice Management (PM) systems to deliver a truly seamless experience — with no need to switch software or disrupt your workflow.
Our team is proficient in all major EHR/PM platforms, including:
We also help practices optimize their system setup, customize reporting, and streamline workflows, so you get the most out of your technology. From claim generation to final payment posting, our integration ensures faster, cleaner claims with minimal disruption.

Leave the Paperwork to Us: Enhance Prior Authorization Now

Streamline your prior authorization process and free up your staff to focus on what truly matters — patient care.
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Frequently asked questions

What types of services require prior authorization?
High-cost imaging (like MRIs), elective surgeries, specialty medications, and some therapies often require PA.
With our team, most PAs are completed within 24–72 hours, depending on payer response.
Yes — we manage PAs for all major commercial payers, Medicare Advantage, and Medicaid plans.
Do you handle appeals if a PA is denied?
Absolutely — we handle all denial resolutions and escalations.
We provide regular status reports, approvals, and real-time updates to keep you informed.
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