Authorization specialists dedicated to your organization, working your payer portals and your queues, recruited and employed by Connext in-country.
Quick answer
A prior authorization team gets payer approval before a service, procedure, or medication is delivered. The work includes checking whether authorization is required, gathering clinical documentation, submitting requests, tracking status, following up with payers, and managing denials and appeals. Connext's teams handle this on the provider's behalf, working with each client's clinical staff on medical-necessity documentation.
Prior authorization is the step where care that has already been decided sits waiting for permission.
Somebody has to submit the request, attach the clinical justification, stay in the payer's portal or on hold until there is an answer, set up the peer-to-peer when the answer is no, and track the authorizations that expire before the patient is ever treated. The AMA counted 39 requests per physician per week and 13 hours of staff time. A prior authorization team is the people who absorb those 13 hours.
Connext Prior Authorization Teams are dedicated specialists who do this all day, inside your system and your payer portals. Your clinicians keep deciding the care. The team keeps it from waiting.
We do not decide your authorizations. We staff the people who chase them, employ them, and keep them hitting the turnaround you need.
Roles scoped in 48 hours and screened against the payers you deal with and the portals you use. You interview the shortlist and you choose. Average time to hire is 21 days.
Connext is the legal employer: contracts, payroll, benefits, local compliance, equipment and secure facilities. You direct the work without opening an entity abroad.
Your EHR stays the system of record, with role-based access and your escalation rules. Every request, call and payer response is logged where your team can see it.
Weekly reviews against the clock you have to meet, QA while the work runs, and retention management that keeps annual attrition near 20% against a 50% industry standard.
Builds and submits the authorization request with the clinical documentation that payer requires, the first time, instead of learning what was missing a week later.
Lives in the payer portal and on the phone until there is a decision, rather than waiting for one to arrive on its own.
Arranges the peer-to-peer review when a request is denied and prepares your clinician for it, so the call takes minutes instead of an afternoon.
Collects what the payer asked for, files the appeal answering the specific reason given, and keeps the record of what was sent and when.
Tracks the authorizations that expire before treatment happens, including the specialty and infusion ones that lapse quietly and are only noticed at billing.
A prior authorization team is usually built one task at a time. Tell us which of the five is costing you the most hours and we will scope that role first.
Scope your first role
When authorizations keep pace, the schedule holds. When they do not, the schedule is what breaks first.
A request that sits for a week is a procedure moved, a patient calling the office to ask why, and a slot that stays empty. An authorization that lapses before treatment is a claim denied after the care was already delivered, which is the most expensive kind there is. Four in ten physicians already have staff working only on this. When one of those seats is empty, there is no slack anywhere else to absorb it.
The rule did not arrive all at once, and two of its three stages are already behind us.
Where Connext fits: the rule assumes you have review capacity you probably do not have. Electronic submission does not remove the clinical review, the documentation or the follow-up. It shortens the time you have to do all three. We recruit and employ the specialists who absorb that work, trained on your payers and your portals before the clock starts, so January arrives as a staffing plan rather than a scramble. Most organizations will meet the deadline with the team they already had. That is the part worth deciding now.
Impacted payers must decide expedited requests within 72 hours and standard ones within seven calendar days, and every denial has to carry a specific reason rather than a generic code.
Payers completed their first annual public reporting cycle on approval rates, denial rates and average processing times. That cycle is behind us, not ahead.
The FHIR-based Prior Authorization API becomes mandatory. It sounds like a technical project with a long runway, which is exactly why most organizations are treating it as one.
The AMA counts 39 requests per physician per week and 13 hours of staff time. Guidehouse and HFMA found 59% of revenue cycle teams have implemented no automation at all. Most organizations are meeting a 72-hour clock with the same people and the same manual workflow they had before the rule existed.
At the point where the waiting starts. You do not have to restructure anything to add a seat.
If requests are going out late or incomplete, that is where we start. It is the cheapest fix and the one that moves the turnaround fastest.
The hold time, the portal checks and the chasing. This is the work that gets dropped first when the front desk is busy, and the work that decides whether the patient is treated this month.
A hiring freeze does not pause the authorizations. A team can carry the queue for a defined period without adding to your headcount.
Electronic submission does not remove the review work, it accelerates the clock around it. Building the review capacity before January is easier than building it after.
Outsourcing the work does not move the authority. These four decisions stay exactly where they are.
Your clinicians.
The team assembles and submits what they documented; it does not interpret the medical necessity.
Your physician.
The team schedules it, gathers the record and briefs them, so the call starts with everything already on the table.
You do.
Connext works inside your contracts and your portals, and escalates to you rather than negotiating on your behalf.
You do, raw.
Submission times, decision times, denial reasons and expiries, in your system rather than in a monthly summary from us.
