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.

ALL MAJOR PAYERS ACCEPTED

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.

RECOVER LOST REVENUE

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.

PREVENTS CLAIM SURPRISES

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. This is our specialty - rare expertise that most practices and vendors simply don’t have.

SPECIALIST EXPERTISE

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.

CLINICAL-GRADE COORDINATION

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.

ZERO COVERAGE GAPS

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. Our team can always be reached to answer questions about your cases.

REAL TIME VISIBILITY

Two Ways We Work Together

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.

We Can Fully Customize Our Service To Be Inserted Anywhere Into Your Workflow