Practice service · every specialty

Prior authorization, closed before the appointment.

The imaging is ordered, the patient is booked, and somebody has to sit on hold with the payer. That job costs a US practice most of a full-time person every week. It is administrative, it is relentless, and it is exactly the kind of work that should not be done by the people you hired to see patients.

Hand this off How a request runs

Approved before the service happensReferral loop closed back to youDenials escalated, not dropped

The prior authorization load

Per physician, per week, across US practices.

Requests handled40 / week

Physician + staff hours spent13 hrs / week

Physicians reporting care delays95%

Source: AMA Prior Authorization Physician Survey, 2025.

How it runs

Nothing is performed before it is approved

The whole point of the service is that no one in your practice discovers the authorization was missing after the service has been delivered.

One authorization, start to finish

Per request

Step 1Order receivedThe order lands with us the moment your provider places it.

Step 2Payer rules checkedWhether this payer requires auth for this code, before anything is submitted.

Step 3Clinical packet builtNotes, prior conservative treatment and imaging pulled from the chart.

Step 4Submitted & trackedPortal where there is one, phone where there is not. Reference number logged.

Step 5Chased dailyPending requests worked every day, not checked when someone remembers.

DoneApproved & scheduledApproval on file, patient booked, referral loop closed back to the PCP.

A denial goes to peer-to-peer with the clinical packet already assembled and a time slot proposed, so your physician spends minutes on the call rather than an afternoon arranging it.

The economics

The cost is staff time on hold

Published industry figures, not OnPoint RCM results.

What one authorization costs to run

Manual prior authorization$12.88

Electronic prior authorization$5.38

Cost per transaction for medical providers. Most of the gap is staff time on hold.

Source: CAQH Index, 2024.

Authorization as a cause of denials

Just over a third of providers put authorization among their leading denial causes — and an authorization denial is the most avoidable kind there is.

Source: Experian Health State of Claims, 2025 — 250 billing decision-makers, multiple answers allowed.

What we handle

The orders that actually get denied

Referrals are the other half: sent on time, appointment set for the patient, and the loop closed back to the referring provider.

Imaging and diagnosticsMRI, CT, echocardiography, nuclear studies, sleep studies — the high-dollar orders payers scrutinize most.

Drugs, injections and infusionsSpecialty medications, biologics and in-office injections, including step-therapy documentation.

Procedures and surgeryAuthorization secured and on file before the date, with the clinical justification the payer asked for.

Division of labor

What we do, and what stays with you

OnPoint RCM does

Checks whether this payer needs auth for this code
Assembles the clinical packet from your chart
Submits by portal, fax or phone as the payer requires
Chases every pending request daily
Arranges peer-to-peer reviews and preps your physician
Sends referrals and books the specialist appointment
Closes the referral loop back to the PCP

Your practice keeps

The clinical decision — what to order and why
The peer-to-peer conversation itself
Which specialists you refer to
Final say on appealing or abandoning a denial

Questions we get

Before you ask

What if the authorization is denied?

We tell you the same day with the payer’s stated reason, and set up the peer-to-peer with the clinical packet ready. If it is genuinely not covered, you find out before the patient is standing at the front desk.

How fast do you turn a request around?

Submission is same-day on anything received during business hours. After that the clock belongs to the payer — what we control is that nothing sits in a queue unworked, and you can see the status of every open request.

Do you handle referrals as well as authorizations?

Yes. Referrals out to specialists, the appointment set for the patient where they want the help, and the consult note chased back so the loop actually closes.

See what your practice is leaving on the table

A 30-minute call. Tell us roughly how many Medicare patients you see, which EMR you use and what you already run in-house. We come back with which programs your patients qualify for, what each one would take to run, and what it is likely to be worth.

Call (636) 634-1229

(636) 634-1229Mon–Fri, 8am–6pm CT

info@onpointrcm.comWe reply the same business day

201 Clarkson Executive ParkEllisville, MO 63011

Request a practice review

Same-day reply. Nothing is billed and no patient is enrolled from this form — it starts a conversation, nothing more.

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