What Should a Prior Authorization Support Workflow Include?
A prior authorization support workflow should give medical practices a clear process for collecting required information, submitting complete requests, tracking payer responses, following up on pending cases, updating patients, and escalating unresolved authorization work before it delays care.
A prior authorization support workflow should give medical practices a clear process for collecting required information, submitting complete requests, tracking payer responses, following up on pending cases, updating patients, and escalating unresolved authorization work before it delays care.
The workflow works best when every authorization has a visible owner, a documented status, and a defined next action. Staff should be able to see what was submitted, what the payer requested, when follow-up is due, and whether an upcoming appointment is at risk.
Portiva provides prior authorization support for healthcare practices that need added administrative capacity for documentation review, payer follow-up, authorization status tracking, patient communication, and escalation under the practice’s established rules.
Portiva has supported healthcare practices since 2009 and provides prior authorization support for administrative tasks such as documentation review, payer follow-up, status tracking, patient communication, and escalation. The workflow gives practices a defined process for moving authorization requests forward while clinical decisions and final treatment responsibility remain with the medical practice.
Why Should Prior Authorization Support Start Before the Visit?
Prior authorization support should start before the visit because missing information or delayed payer action can put a scheduled service at risk. Early review gives the practice more time to correct documentation, contact the payer, update the patient, or escalate a request before the appointment date.
Why Does the First Authorization Submission Matter?
The first authorization submission matters because incomplete or inconsistent information can create avoidable rework. A strong first pass checks the required patient, provider, procedure, insurance, and supporting documentation details before the request enters the payer’s review process.
What Should Happen When a Prior Authorization Is Pending?
A pending prior authorization should have a documented status, a named owner, a follow-up date, and a clear next action. Staff should not have to search through notes or separate systems to determine whether the payer needs more information or whether another follow-up is due.
Who Should Own Each Prior Authorization Task?
Each prior authorization task should have one clearly identified owner at every stage of the workflow. Clear ownership reduces duplicated calls, missed follow-ups, and uncertainty about who is responsible for contacting the payer, updating the record, or escalating the case.
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Portiva provides top-tier virtual medical assistant services designed to enhance healthcare efficiency.
When Should a Prior Authorization Be Escalated?
A prior authorization should be escalated when the request cannot move forward through the normal administrative workflow or when a scheduled service is approaching without a clear payer determination. Escalation rules should be defined by the medical practice and documented so staff know exactly when internal review is required.
What Should Patients Be Told About a Pending Authorization?
Patients should receive clear status information about what is known, what is still pending, and what the practice is doing next. Administrative staff should avoid making promises about payer decisions and should communicate only the status and next steps supported by the authorization record.
What Does Portiva Handle in a Prior Authorization Workflow?
Portiva supports the administrative parts of a prior authorization workflow, including documentation checks, payer follow-up, status tracking, patient communication, and escalation based on practice rules. Clinical decisions, medical necessity determinations, and treatment decisions remain with the healthcare provider.
── WHO'S BEHIND THIS
Provider Profile
Sanju Zachariah
Founder & CEO, Portiva
Sanju Zachariah is the Founder and CEO of Portiva, a healthcare staffing company he established in 2009 to help medical practices reduce administrative burdens and operate more efficiently. Before founding Portiva, Sanju worked as a management consultant at Accenture and PwC, where he gained extensive experience in process improvement and operational strategy.
Inspired by firsthand frustrations with inefficiencies in healthcare administration, he built Portiva to provide scalable virtual support that allows healthcare professionals and business leaders to focus on higher-value work.
2009
3
US
Frequently Asked Questions
Is prior authorization support a good fit for a small practice?
Yes, if authorization follow-up is pulling trained staff away from scheduling, patient communication, billing, or clinical support. The fit is strongest when requests are frequent enough to need a repeatable queue and clear ownership.
