Complete Authorization Management for Pediatric Practices
We handle the full range of authorization services pediatric practices need most — from routine prior auths to complex specialty medications, TRICARE ECHO, denial appeals, and peer-to-peer coordination.
Prior Authorization Submission & Tracking
End-to-end management from documentation pull through payer approval. Specialty referrals, procedures, imaging, laboratory tests, and medications requiring payer approval. We document medical necessity in the language payers respond to.
Denial Appeals & Peer-to-Peer Coordination
Every denial fought to the highest level — medical necessity letters, P2P physician prep, escalations. We don’t let denials die. We fight them with clinical language that works.
Insurance Verification & Eligibility
Real-time benefit checks before the patient even walks in the door. Eligibility checks, benefit breakdowns, copay and deductible confirmation, and prior-auth requirement identification — before every visit or procedure.
TRICARE, ECHO & Virginia Medicaid
Deep expertise in Cardinal Care MCOs, TRICARE East (Humana Military + Availity), TRICARE West (TriWest via Availity), and ECHO navigation for special-needs military dependents. Rare expertise that most practices and vendors simply don’t have.
RSV & Specialty Medication Programs
Seasonal prophylaxis coordination for RSV agents (nirsevimab, clesrovimab), biologic therapies (Dupixent, Xolair, Humira), growth hormone programs, and complex specialty medications requiring ongoing auth management.
Reauthorization Tracking & Renewals
Proactive monitoring — nothing expires, nothing falls through the cracks. ABA reauths every 60–90 days, biologic renewals, growth hormone velocity tracking, GnRH quarterly injections — all tracked and submitted before deadlines hit.
Tracking & Reporting
Weekly status updates every Friday. Full authorization queue visibility — pending, approved, denied, and in appeal. You’re never in the dark on a case, and our team can always be reached to answer questions about your cases.
Two Ways We Work Together
Pick the integration model that fits your practice. Both deliver the same clinical-grade work.
Full EHR Integration
Jennifer is set up with her own credentials in your EHR. She accesses the system directly, pulls the necessary documentation, builds the auth packages, submits to payer portals, and tracks everything. Your staff only needs to notify her of a new patient needing authorization.
Documentation Packages
For paper-based practices without an EHR. Your staff sends Jennifer the clinical documentation — she reviews it with clinical judgment, builds the auth package, submits, and tracks.
Authorization Management Only.
We don’t handle claims, billing, or accounts receivable. Our singular focus is the part of your revenue cycle that drains the most clinical staff time — prior auths, denials, and reauths. We work alongside your existing billing company or biller; we don’t replace them.
See If We’re a Fit
30 minutes. No pressure. We’ll walk through your current auth workflow and show you where we’d plug in.
Request a Free Consultation