Your foundation for faster approvals. Outsource prior authorization to AAPC-credentialed PA specialists with 12 payer-specific desks. Real-time prior authorization services covering benefit verification, medical necessity, payer portal submission, peer-to-peer, and appeals. Built for groups that want fewer denials, CMS-0057-F readiness, and daily exception visibility.
“They cleared a 4-month PA backlog in 14 days.” Our staff work from secured facilities in India, Pakistan, and Bangladesh.
Dr. Miladys Palau · Pediatric Endocrinologist · TopLine MD Alliance
Single specialty or multi-site? Drug PA, procedure PA, or full clinical? Send us your situation and we map the right prior authorization desk.
Prior authorization is the approval a health plan requires before it will cover a medication, procedure, imaging study, or admission so your team confirms medical necessity, gathers documentation, and submits to the payer before the service is delivered.
Staffingly’s remote, AAPC-credentialed PA specialists run benefit verification, medical necessity documentation, payer portal and electronic prior authorization (ePA) submission, peer-to-peer coordination, and appeals from a HIPAA-compliant environment, posting results straight into your EHR across all 50 states.
It is not a chatbot. Every authorization is run and reviewed by a credentialed specialist (RN, PharmD, MD, or AAPC-certified administrator) under HIPAA-compliant conditions with a signed BAA. AI tools assist with CPT and ICD extraction and payer policy lookup; a human signs off on anything that touches patient data.
Our prior authorization outsourcing program combines AAPC-credentialed prior auth specialists with intelligent automation for a hybrid approach to PA workflow. Whether your practice needs urgent prior authorization, retrospective PA, electronic prior authorization (ePA) submission, peer-to-peer coordination, denial tracking, step-therapy override, or specialty PA across cardiology, oncology, neurology, GLP-1, biologics, MS DMTs, and Spravato, our team uses AI-driven workflow tools alongside human specialists to handle benefit verification, medical necessity documentation, payer portal submission, and EHR updates inside your existing platform.
All prior authorization services are HIPAA-compliant, SOC 2 Type II certified, ISO 27001 certified, and HITRUST CSF aligned. Every PA specialist is an overseas-educated healthcare professional (RN, PharmD, MD, or AAPC-credentialed administrator) supported by intelligent automation for CPT and ICD extraction, payer policy lookup, and pre-submission scrubbing. Available across all 50 states. Per-auth pricing starts at $4 to $8. Dedicated PA specialist starts at $399 per role per week ($349 at volume) with a 2-Week Risk-Free Pilot.
Imagine we are sitting across from each other, sipping coffee. You ask, “What is the big deal with prior authorization?” Think of it as the gate that decides whether the payer covers a procedure, drug, or imaging study before service. Get it right and revenue flows clean. Get it wrong and you eat denials, reschedules, and angry patient calls.
Prior authorization (also called pre-auth or pre-cert) is the payer’s approval gate before service. Without it on file, claims for the procedure, drug, or imaging study get denied or rejected. It applies to imaging, surgery, specialty drugs, GLP-1, biologics, behavioral health, and DMEPOS.
Six recurring causes: incomplete medical necessity documentation, missing CPT or ICD codes, payer-policy misalignment, expired auth windows, step-therapy gaps, and out-of-network rendering provider issues. Pre-submission scrubbing catches all six before the claim ships.
ePA uses CoverMyMeds, Surescripts, Availity, or direct payer FHIR APIs to submit and track in real time. CMS-0057-F (effective Jan 1, 2026 for impacted payers: MA, Medicaid FFS/MC, CHIP FFS/MC, FFE QHPs) mandates 7-day standard windows and 72-hour expedited windows. First public reporting deadline was March 31, 2026.
A healthcare-trained pro (RN, PharmD, MD, or AAPC-credentialed admin) who runs the full PA workflow: benefit verification, medical necessity docs, payer portal submission, status tracking, peer-to-peer prep, and appeals. Clinical decisions stay with your providers.
Three pieces working together: tight processes, AI-powered technology, and a payer-fluent expert team. Here is what you get when all three line up.
A well-oiled machine for prior authorization. Predictable, accurate, fast.
Work smarter, not harder. AI handles 80%, specialists own the 20% that needs judgment.
Healthcare-trained, payer-fluent specialists matched to your specialty and EHR.
If you are thinking about how outsourcing PA can move the needle, here are the wins that show up in the first 90 days.
By outsourcing, you cut the need for extra in-house PA staff. Reducing denied claims compounds the savings. Most clients save up to 70 percent versus a $52,000 to $78,000 fully loaded in-house PA coordinator.
Specialists track CMS-0057-F windows, payer policy updates, and step-therapy criteria daily. SOC 2 Type II, ISO 27001, HITRUST CSF aligned.
Your team gets back to patient care. We run the PA workflow end-to-end inside your existing EHR. They keep the relationships.
4-hour standard submission SLA. High first-pass approval rates and strong peer-to-peer outcomes anchored to the 81.7% appeal overturn rate documented in the 2024 AMA PA survey. Procedures get scheduled, not rescheduled.
70% Savings · Live in 48 Hours · Virtual MDs & RNs · HIPAA Compliant · 2-Week Risk-Free Pilot
We collect and review patient demographics, medical documentation, and insurance coverage using AI-based eligibility tools to confirm benefits and identify missing data. AI + automation enabled for efficiency and speed.
Our PA specialists prepare detailed prior authorization requests supported by clinical guidelines, codes, and payer policies to maximize approval rates. AI + automation enabled for efficiency and speed.
Requests are submitted via payer portals (Availity, NaviNet, CoverMyMeds) or EMR integration. We manage all major insurers including UnitedHealthcare, Aetna, Cigna, and Medicare. AI + automation enabled for efficiency and speed.
We work closely with physicians, nurses, and pharmacies to gather missing info and provide real-time status updates to your team, including patients. AI + automation enabled for efficiency and speed.
Every request is monitored until final determination. Our team manages appeals and renewals to prevent gaps in patient care. AI + automation enabled for efficiency and speed.
Through AI-analytics and process monitoring, we refine workflows, improve turnaround times, and ensure compliance with payer and regulatory standards. AI + automation enabled for efficiency and speed.
An intake queue that gathers documentation, a live submission desk that files to payer portals, and an approvals desk that runs peer-to-peer and appeals. Tap through the workflow.
We pull the order, confirm the plan’s PA requirement, and gather chart notes and clinical documentation before submission.
Specialists assemble the medical necessity packet to payer criteria, with CPT and ICD codes extracted and checked.
Electronic prior authorization (ePA) and portal submission to the payer, with reference numbers logged in your EHR.
When a payer requests a peer-to-peer review, we schedule it and prep the provider with the clinical talking points.
Denials are tracked, root-caused, and appealed with payer-specific letters and supporting documentation.
Every authorization number, status, and expiration date is posted directly into your EHR. No double data entry.
We do not just throw bodies at the problem. Our workflows combine intelligent automation, machine-assisted payer verification, and trained clinical specialists to deliver results faster, cheaper, and more accurately than any in-house team.
Rigorous QA on every submission. AI validates each authorization against payer rules before submission and an AAPC-credentialed specialist signs off.
Real-time verification across 1500+ payer networks. Results in seconds, not hours.
AI identifies denial patterns, improves submission timing, and predicts approval likelihood.
Automated payer follow-ups and status tracking. Nothing gets lost. Nothing gets delayed.
Five-minute walkthrough: payer-specific desks, ePA submissions, batch PA submission, denial recovery, and how a 10-location group cut PA-related denials by 62 percent.
How Staffingly clears prior auth backlogs across every specialty.
Five minutes inside our PA operation, from intake to approval, for 800+ providers.
Four practices, four specialties, four Google reviews. Read what dermatology, orthopedic, psychiatry, and telemedicine practice owners said after partnering with Staffingly.
“Staffingly has made a positive impact on our overall AR, verification as well as prior authorization. Patient and knowledgeable employees.”
“Very competent staff including Sai Gannoji who was particularly helpful transferring records to my NY doctor.” Praised by both the admin and a patient by name.
“My medical practice is focused on Neuropsychiatry and Sleep Medicine. For the first time we have the experience of using a virtual medical assistant via Staffingly Inc. They provided highly trained staff, meeting all the professional and ethical standards.”
“We engaged Staffingly for prior authorization support, and the performance met operational standards. Attention to detail, responsible follow-ups, daily updates, transparent workflow.”
Every prior authorization workflow we run, organized by buyer intent. Specialty PA, drug class PA, procedure PA, workflow PA, payer-specific PA, and EMR/setting PA.
Specialty-trained PA specialists who know your codes, your payer rules, and your medical necessity language. Day-1 productivity, not 6-week ramp.
Stress tests, echo, cath, EP, implants, cardiac MRI.
Chemo, infusion, radiation, regimen changes.
Joint, spine, sports, trauma.
Biologics, Mohs, photo, cosmetics.
MS, migraine, EMG, EEG, infusions.
Inpatient psych, IOP, PHP, ABA, TMS, ECT.
Endoscopy, IBD biologics, motility.
Biologics, infusions, step therapy.
Asthma biologics, sleep, oxygen, CPAP.
Diabetes, GLP-1, thyroid, growth hormone.
Spravato, TMS, atypical antipsychotics.
CT, MRI, MRA, PET, nuclear medicine.
High-volume drug PA paths covering GLP-1 (consolidated), biologics, oncology agents, MS DMTs, Spravato, and other specialty medications.
Wegovy, Ozempic, Mounjaro, Zepbound, Saxenda, Trulicity.
Humira, Dupixent, Skyrizi, Stelara.
Targeted, immunotherapy, hormone therapy.
REMS-compliant Spravato (esketamine).
Ocrevus, Tysabri, Kesimpta, Mavenclad.
Aimovig, Emgality, Ajovy, Vyepti.
Dupixent, Nucala, Fasenra, Tezspire.
Dupixent, Adbry, Rinvoq, Cibinqo.
Takhzyro, Cinryze, Haegarda, Berinert.
Mavyret, Epclusa, Vosevi, Harvoni.
Biktarvy, Cabenuva, Apretude, Sunlenca.
Vyvanse, Adderall XR, Concerta, Jornay.
Chimeric antigen receptor T-cell cancer therapies.
Crohn’s disease and ulcerative colitis biologics.
PD-1, PD-L1 inhibitors, and targeted oncology biologics.
Imaging, surgical, and procedural PA paths covering MRI, CT, PET, joint replacement, spine surgery, sleep studies, IVF, colonoscopy, and infusion therapy.
eviCore, Carelon, AIM gates for MRI imaging.
High-resolution CT, CTA, and low-dose scans.
Oncologic, cardiac, and neurologic PET imaging.
Hip, knee, shoulder arthroplasty.
Fusion, decompression, hardware.
Diagnostic, interventional, EP.
Polysomnography, HSAT, CPAP, BiPAP.
Fertility benefits, retrieval, transfer.
Screening, surveillance, diagnostic.
In-office, ambulatory, home.
Cardiac radiofrequency and cryoablation for arrhythmias.
Electromyography and nerve conduction studies.
Workflow-specific PA paths for urgent submissions, retro auths, concurrent review, ePA, peer-to-peer scheduling, appeals, and denial routing.
72-hour CMS-0057-F windows.
Post-service auth, claim recovery.
Inpatient level-of-care reviews and authorizations.
Day-by-day inpatient stay extensions and authorizations.
CoverMyMeds, Surescripts, FHIR APIs.
Provider scheduling, prep packets.
Medical necessity letters, evidence.
Reason codes, payer pattern analysis.
Medical exception, prior trial docs.
External independent medical review submissions.
NSA-aligned Independent Dispute Resolution filings.
Transition authorization for new or moving patients.
Payer-fluent PA teams for the major commercial, government, and managed-care payers. Each path tracks the payer’s portal, criteria, escalation steps, and denial patterns.
MA, FFS, DMEPOS, ESRD.
State Medicaid, MCO, CHIP.
Commercial, MA, Aetna Better Health.
Commercial, eviCore, Cigna Healthcare.
Local plans, Anthem, Highmark.
Commercial, MA, UHC Provider Portal.
MA, commercial, Humana Pharmacy.
Tricare Prime, Select, For Life.
PBM, specialty, infusion.
Anthem BCBS, Carelon, Elevance.
Medicaid, MA, Marketplace.
Ambetter, WellCare, Health Net.
Consolidated EMR/EHR PA path covering Epic, Athena, eCW, NextGen, Cerner, ModMed, plus setting-specific PA for hospital, ASC, infusion, telehealth, and SNF.
Epic, Athena, eCW, NextGen, Cerner, ModMed.
Pre-admission, observation, IP review.
Outpatient surgery, place-of-service.
In-office buy-and-bill, J-codes.
Cross-state, behavioral, follow-up.
Skilled nursing, inpatient rehab.
OASIS, plan-of-care, recertification.
Wegovy, Ozempic, Mounjaro, Zepbound, Saxenda, Trulicity, Rybelsus, Victoza. Step therapy, BMI documentation, comorbidity citations, payer-specific criteria, peer-to-peer prep, appeals, and 90-day plus annual renewals. Pick the workflow your practice needs.
Consolidated workflow covering Wegovy, Ozempic, Mounjaro, Zepbound, Saxenda, Trulicity, Rybelsus, Victoza.
View workflow
Type 2 diabetes coverage, A1C threshold, prior therapy, payer-specific criteria for semaglutide.
View workflow
BMI threshold (30+ or 27+ with comorbidity), prior diet history, lifestyle modification documentation.
View workflow
Tirzepatide for Type 2 diabetes. Step therapy through metformin, A1C documentation, comorbidity citations.
View workflow
Tirzepatide for chronic weight management. BMI gates, comorbidity proof, prior weight-loss therapy log.
View workflow
Dulaglutide for Type 2 diabetes. Weekly dosing, A1C documentation, prior therapy through metformin and SGLT2.
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Medical exception requests, prior therapy documentation, intolerance proof, payer-specific override paths.
View workflow
First-level appeals, peer-to-peer prep with NCCN-aligned evidence, plus 90-day and annual renewals with continuation criteria.
View workflowPer-role weekly pricing that scales with your headcount. No setup fees. No long-term contracts. 2-Week Risk-Free Pilot.
1-2 PA FTEs, single-location practice
3-9 FTEs, multi-provider group
10-19 FTEs, multi-location group
Per-auth pricing also available from $4 to $8 per authorization. In-house comparison: $55K to $84K fully loaded per US-based PA specialist. Per-FTE pricing typically saves 60-70% annually.
Custom workflows, dedicated account teams, and volume terms for MSOs, hospital groups, FQHCs, and multi-location organizations.
Estimated savings vary by claim volume, denial rates, specialty mix, payer mix, and current staffing model. In-house comparison anchored at $77,000 fully loaded per PA specialist (BLS median plus 30-50% loaded benefits). Numbers shown are illustrative averages from MGMA and HFMA benchmarks plus Staffingly client averages.
Where prior auth is going. AI automations, CMS regulations, EMR integrations, and the data behind every approval. Here is what is changing and what we have built for it.
AI extracts CPT, ICD-10, J-codes, and chart notes, then auto-fills payer forms. Specialists review and sign off on the 20% that needs human judgment.
Routine PA submissions go out within 4 business hours. Urgent and expedited go same-day. Status checks every 24 to 48 hours until determination.
Effective Jan 1, 2026. Operational compliance now mandatory for Medicare Advantage, Medicaid managed care, CHIP, and FFE QHP issuers. Public reporting due Mar 31, 2026.
CMS-0057-F requires impacted payers to implement FHIR-based ePA APIs by January 1, 2027. We map payer endpoints as they go live so practices benefit from speed gains immediately.
Epic, Athenahealth, Oracle Cerner, eClinicalWorks, NextGen, AdvancedMD, ModMed, Kareo/Tebra, DrChrono, Practice Fusion, Allscripts, MEDITECH, and more. No new software to install.
AI denial analytics flag payer-specific patterns before submission. Pre-submission scrubbing checks every PA against payer rules. Industry baseline runs 70 to 80 percent.
AI prep packets, scheduling automation, and clinical talking-point libraries. Voice agents (Claude 4.5 Haiku + Retell AI + Keragon) handle scheduling so specialists run the call.
Aetna, Cigna, BCBS, UHC, Humana, Tricare, Anthem, Optum, Molina, Centene, Medicare, Medicaid. Each desk tracks the payer’s portal, criteria, escalation steps, and denial patterns daily.
Our onboarding process is designed to integrate our PA specialists into your practice smoothly, with no disruption to your operations.
We assess your practice’s needs and outline the specific verification services that would benefit you the most.
Based on your requirements, we present a tailored proposal outlining our services and how they will be implemented.
Our team works closely with your practice to ensure that our PA specialists integrate into your existing workflows, systems, and processes.
We provide continuous support and adjustments to keep your practice running smoothly and efficiently.
At the end of the day, handling prior authorization should not feel like pulling teeth. By outsourcing to Staffingly, you can simplify this critical process, save time, reduce costs, and ensure that your patients receive the care they need without the financial headaches.
Industry standards, regulatory frameworks, and benchmark data we reference on this page.
Dan Nandan is the President and CEO of Staffingly With 25+ years in IT consulting and healthcare BPO operations, he was one of the earliest U.S. operators to set up an RPO/BPO delivery network in India over 20 years ago. Today his work centers on AI-driven healthcare workflows and helping practices across North America cut administrative costs without compromising care.
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Bincy Shiiju Kuriakose is a Clinical Content Reviewer at Staffingly and a U.S. Licensed Registered Nurse (MSN, RN). NCLEX-RN certified with expertise in hospital nursing, telehealth, and nursing education. Reviews every service page for medical accuracy, compliance, and evidence-based best practices.
Connect on LinkedInAdditional service pages we maintain. Click for detailed scope, payer specifics, and pricing for each.
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