Missing a prior authorization means a denied claim and a delayed patient — and auth requirements change constantly. We determine what needs authorization, submit and track every request, and appeal auth denials, so procedures happen on time and the revenue behind them is never lost to a preventable auth gap.
HIPAA-compliant, Fort Worth, Texas-based revenue cycle management. Scionis RCM operates under strict data-privacy protocols and standardized billing methodologies aligned to HIPAA requirements, helping US healthcare practices reduce compliance and audit exposure across every specialty we serve.
Prior authorization is one of the most burdensome and error-prone parts of the revenue cycle — a missed or late auth doesn't just deny a claim, it delays a patient's care.
Missed authorizations: procedures performed without a required auth become hard denials
Slow approvals: manual auth processes delay procedures and frustrate patients and providers
Shifting requirements: payer auth rules change constantly, and missing an update causes denials
Poor follow-up: submitted auths that aren't tracked stall, expire, or get lost before service
Sound familiar? At Scionis RCM, we own the entire prior authorization process, so nothing required is ever missed and care is never needlessly delayed.
Get a Free Prior Auth ReviewOur specialists determine exactly what requires authorization, submit complete requests with the right clinical documentation, track every request to approval, and appeal auth denials when they happen. Securing authorizations before service is what keeps procedures on schedule and prevents the denials that unauthorized care guarantees.
We verify exactly which services, procedures, and medications require prior authorization for each payer before service.
Auth requests submitted with the clinical documentation and medical necessity support payers require to approve.
Every request tracked to approval with regular payer follow-up, so nothing stalls, expires, or gets lost.
When authorizations are denied, we appeal quickly with the documentation needed to overturn the decision.
Retroactive and expedited authorization handling for urgent cases and services already rendered where allowed.
Continuous tracking of changing payer authorization rules so a requirement update never causes a denial.
Authorization requirements vary by service, payer, and setting — imaging, surgery, infusion, DME, and specialty medications each have their own rules. We manage authorizations across all of them, so nothing that needs approval slips through before service.
Prior authorization for MRI, CT, PET, and other advanced imaging that payers routinely require.
Authorization for scheduled surgeries and procedures, submitted with medical necessity documentation.
Authorization for infusions, injectables, and specialty medications, including buy-and-bill workflows.
Prior authorization for durable medical equipment with the documentation each payer requires.
Authorization for behavioral and mental health services and ongoing treatment, tied to our specialty billing.
Expedited authorization for time-sensitive cases so urgent care isn't delayed by paperwork.
Retroactive authorization requests for eligible services already rendered where payers permit.
Fast appeals of denied authorizations with the clinical support needed to overturn them.
Coordinating referrals and authorizations together so specialist visits aren't denied on either.
A missing prior authorization is one of the most preventable causes of denied claims, and unlike most denials, it also delays the patient's care. Prior authorization is burdensome, constantly changing, and unforgiving of mistakes. We own the entire process, determining what requires authorization, submitting complete requests, tracking every one to approval, and appealing auth denials, so procedures stay on schedule and the revenue behind them is protected.
Prior authorization sits at the front of the revenue cycle alongside eligibility, which makes it the cheapest place to prevent a denial, securing a required authorization before service costs a submission, while missing it costs a hard denial that often cannot be appealed at all.
Prior authorization is consistently ranked among the heaviest administrative burdens in healthcare, and for good reason: requirements differ by payer and change frequently, requests demand specific clinical documentation, and a service performed without a required auth typically becomes a hard denial that can't be appealed. Because the failure point is usually a missed or late authorization rather than a clinical issue, the entire problem is preventable with a disciplined process. This work pairs directly with our eligibility verification process.
The single most important principle in prior authorization is securing it before service is rendered. Once a procedure is performed without a required authorization, the resulting denial is often final. Our specialists determine requirements during scheduling, submit complete requests early, and track them to approval, so procedures are authorized before they happen rather than denied after.
When an authorization is denied, we appeal quickly with the clinical support needed to overturn it, and we handle expedited authorizations for time-sensitive cases and retroactive requests where payers allow. Auth denials that do occur feed into our broader denial management process, so no recoverable authorization is left unworked.
Payer authorization rules change constantly, and a requirement you didn't know about is still a denial. We continuously monitor changing authorization requirements across payers, so your practice stays current and a rule change never quietly turns an authorized service into a denied one. Staying ahead of requirements is what keeps the whole process reliable.
Prior authorization is where preventable denials and care delays are either stopped or created. By owning determination, submission, tracking, and appeals, and by staying ahead of constantly changing requirements, we keep procedures on schedule and protect the revenue that a single missed authorization would otherwise cost you.
Effective prior authorization pays off in two places at once: patients get their care on time, and the practice avoids the hard denials that unauthorized services guarantee.
By determining requirements up front and securing authorizations before service, we prevent the auth-related denials that are among the hardest to recover once they occur. Because an unauthorized service is often a final denial, preventing it is worth far more than any downstream appeal, which is why front-end authorization discipline directly protects revenue.
Prior authorization is one of the most time-consuming administrative tasks in any practice, full of payer phone calls, portals, and paperwork. Moving it to a dedicated team removes that burden from your front desk and clinical staff while ensuring it's actually done completely and on time, so your people can focus on patients instead of payer portals.
Because a service performed without a required authorization usually becomes an unappealable denial, prior authorization is one of the few revenue-cycle steps where prevention is the only real remedy, making front-end discipline essential rather than optional.
As a billing company, we have worked with several RCM vendors, but none have matched the level of service and results we've seen with Scionis RCM. Their technology-driven solutions and expert team have made our processes smoother and more efficient, which has led to increased client satisfaction. They are truly a trusted partner.
Our healthcare network has greatly benefited from the efficient and accurate services provided by Scionis RCM. Their commitment to reducing administrative burden and optimizing our revenue cycle has been a key factor in our growth and success. They are not just a service provider but a vital extension of our team.
Partnering with Scionis RCM has been a game changer for our practice. Their expertise in streamlining revenue cycle management has allowed us to focus on what we do best, caring for our patients. They have significantly reduced our claim denials and improved our cash flow. We couldn't ask for a better partner.
End-to-end management: determining what requires authorization, submitting complete requests with clinical documentation, tracking every request to approval, and appealing auth denials when they occur.
When a service that requires prior authorization is performed without one, payers typically issue a hard denial that often can't be appealed, which is why securing authorization before service is essential.
We continuously monitor payer authorization rules, which change frequently, so a requirement update never quietly turns an authorized service into a denied one.
Yes. We manage prior authorization for advanced imaging (MRI, CT, PET), scheduled surgeries and procedures, infusions and specialty drugs, DME, and behavioral health, among others.
Yes. When an authorization is denied, we appeal quickly with the clinical documentation needed to overturn the decision, and connect it to our denial management process.
Yes. We prioritize expedited authorization for time-sensitive cases so urgent care isn't delayed by paperwork, and handle retroactive requests where payers permit.
They're both front-end steps done before service. We verify eligibility and determine authorization requirements together, so coverage and authorization are both confirmed before care.
Yes. Prior authorization is one of the most time-consuming administrative tasks in a practice. We take it off your front desk and clinical staff while ensuring it's done completely and on time.
Reducing Medicaid denials for a behavioral health provider through authorization-linked coding.
Read more
Why behavioral health Medicaid claims deny — and how to prevent the repeat.
Read more
A closer look at coding workflow optimization for a multi-site radiology group.
Read more