- (773)-985-1869
- info@stream-rcm.com
- 14430 Ocean Point, El Paso, TX 79938
Our prior authorization services assist healthcare providers in obtaining pre-approvals from insurance companies for treatments, procedures, and medications. Stream RCM is a trusted prior authorization company which supports healthcare providers to minimize denials to ensure smooth communication with insurance companies. We help hospitals, clinics, and medical specialty practices with proper and compliant processes that meet the standards of the Centers for Medicare & Medicaid Services and HIPAA.
Prior authorization for medical services is a payer condition whereby providers must seek prior approval from the payer before providing certain healthcare services. Pre authorization confirms that the service is medically necessary and covered by the insurance plan of the patient.
Healthcare prior authorization services certify that all clinical notes, documentation, and coding information are submitted appropriately. This supports reducing processing delays and improves communication between insurance companies and providers.
Prevents Claim Denials and Rework
Accurate insurance prior approval services can prevent costly denials. Proper submissions can reduce claim rework, improve clean claim rates, and support steady cash flow for healthcare organizations.
Ensures Medical Necessity Compliance
Insurance prior approval services confirm the payer guidelines and clinical standards before treatment. These safety measures for providers from audits ensure compliance with payer and regulatory guidelines.
Improves Patient Financial Transparency
Prior authorization outsourcing services assist in understanding insurance coverage details early to enable patients to know their benefits, estimated costs, and expected approval timelines before any procedures.
We outsource prior authorization services to help reduce the workload of staff, as well as improve turnaround times, and allow practices to focus more on patient care and less on administrative tasks.
Insurance companies utilize insurance pre approval to verify medical necessity, manage costs, and confirm that treatments meet coverage requirements before authorizing payment. This process also helps prevent claim denials and confirms patients receive appropriate care on time, whereas keeping providers up-to-date and compliant with insurance policies.
Outsource prior authorization solutions company services decrease internal workload. Your staff will spend less time on phone calls, paperwork, and payer portals while we handle follow-ups.
Efficient medical prior authorization services reduce treatment delays. Faster approvals enable improved scheduling, faster billing cycles, and improved overall revenue performance.
Expert authorization providers review payer policies carefully. Incomplete submissions can be avoided, errors are lowered, and continuous communication with insurers is minimized.
Insurance pre-approval supports to minimize rearranging of appointments. Patients get clearer timelines and less billing surprises which lead to better satisfaction and trust.
Our prior authorization outsourcing process follows structured steps, secure data handling, and payer-specific guidelines to ensure timely approvals and complete compliance.
We confirm eligibility, coverage limits, and referral requirements before submission to prevent avoidable denials and delays in authorization.
Our specialists validate medical records, CPT codes, and diagnosis details to match payer criteria and strengthen approval chances.
We submit requests through portals, fax, or phone and track each case until a final decision is received.
Regular follow-ups and reporting keep providers informed about pending, approved, or denied authorization cases.
Authorization denial cases are often due to incomplete documentation, missed payer guidelines, or delayed submissions. Our organized pre authorization solutions company approach proactively addresses these gaps.
Reason for Denial
Our Solution
The denial of claims is attributed to missing notes, improper coding, or a lack of sufficient information on medical necessity in most cases. We perform in-depth chart reviews, verify CPT and ICD codes, and confirm that payer-specific clinical criteria are documented.
Top prior authorization companies have their own set of policies and changing requirements. Our team is always tracking payer updates, confirming policy changes, and synchronizing submissions based on these to avoid unnecessary rejections or repeated submissions.
Late submissions may postpone treatment or reimbursement. We use strict tracking systems, defined turnaround times, and proactive follow-ups to ensure that every authorization request is submitted and tracked on a timely basis.
Request a free consultation and customized prior authorization outsourcing services plan based on your specialty, payer mix, and patient volume. We analyze your workflows, identify gaps, and make recommendations.
We manage prior authorizations for medical procedures for a wide range of specialties to ensure accuracy and quick insurance approvals.
Caths, Echoes, Implants
Joint, Spine, Trauma
Chemo, Radiation, Biologics
MRI, CT, PET
Colonoscopy, Endoscopy, Biopsy
Injections, Nerve, Ablation
Stream RCM is one of the top prior authorization companies that offer affordable prior authorization services with experienced specialists, HIPAA-compliant workflows, and proven results. Our team reduces denials, accelerates approvals, and streamlines processes for healthcare providers, ensuring efficient, accurate, and stress-free insurance pre approval management.
Our team of experts is equipped to handle each prior authorization request with precision, knowledge of payer guidelines, and expertise in clinical documentation. This helps to minimize errors, expedite approvals, and ensure that healthcare providers spend less time on administrative work and more time with patients.
Stream RCM helps in submitting claims on time, following up on them proactively, and tracking them accurately with an organized and HIPAA-compliant workflow. Our workflow helps in reducing delays, increasing the rate of clean claims to ensure transparency at every stage of the authorization process.
We integrate with your practice systems, providing real-time updates, reporting, and consultation. Our approach decreases administrative work, increases patient satisfaction, and ensures healthcare providers have smoother prior authorization results by our healthcare prior authorization services.
The prior authorization service is a process whereby the insurance company reviews and authorizes a medical treatment, procedure, or drug before it is delivered. The service ensures that the medical treatment is covered and that it is medically necessary.
Patients are not in a position to do prior authorizations on their own because insurance companies demand clinical documentation from healthcare providers. This process is taken care of by healthcare providers or companies that specialize in prior authorizations.
The two main categories are standard authorization, which requires more than a few days for processing, and urgent or expedited authorization, which needs time sensitive measures. Both categories confirm insurance approval prior to procedures, but urgent authorization is processed faster to avoid delays in treatment.
The time required for approval also varies depending on the insurance company and the procedure. The standard prior authorization may require 3-10 business days, but urgent prior authorizations can be completed within 24-72 hours. This is because there may be delays in the documentation or clinical information.
Yes, referral to your doctor is usually necessary because they provide medical information. Patients can provide insurance information, but it is up to the provider to provide the correct information to the insurance company for processing.
Prior authorization is a constructive process as it certifies that the treatment is medically necessary and covered by insurance. Though, it may lead to delays and additional steps for patients and providers if it is not managed professionally.
Partner with a trusted prior authorization provider for accurate and timely approvals.
