Faster Prior Authorization Services. Accurate Eligibility Verification.
Advantum One does all the work for you with exceptional prior authorization and eligibility services that save time and money.
According to a 2020 survey by the American Medical Association, 94% of physicians report care delays due to an insurance company’s prior authorization requirements. At Advantum, we aim to fix this. Using our proprietary Advantum One platform, we simplify the entire process for you, including managing and reviewing multiple orders with 24/7 access to a secured, online dashboard. We also track the status of all your submissions through the online portal and avoid costly services that result in denials or failed reimbursements.
Prior Auth & Eligibility Verification Services
- Process optimization
- Coverage, eligibility and benefits verification
- Preparation and submission of all required paperwork
- Expert completion of appropriate criteria sheets and forms
- Follow up on pre-auth requests
- Patient account updates
How It Works
Our goal is to remove the stress from prior authorization and eligibility verification. We have the ability to connect to any EHR or PM system to pull in calendar and order requests. We then submit electronically or via fax all information to the payer. Our easy-to-use dashboards provide clear analytics of your orders from submission through approval status.
Advantum One features include:
- Bulk imports and exports of orders and status results
- Centralized location for maintaining patient information and documentation
- Submission of orders to payers via an EDI 278 transaction, fax or online
- Customizable user roles and security access
- Manageable patient appointments with color-coded calendar views and status results
Prior Authorization FAQ
How Can I Speed Up the Prior Authorization Process?
You can speed up the prior auth process by submitting complete, accurate documentation the first time and using electronic prior authorization (ePA) tools.
Missing details, incorrect codes, and manual steps often slow approvals. Providers who adopt automation generally see faster turnaround times and fewer rejections, especially when workflows are well-coordinated across clinical and billing teams.
Advantum Health’s specialists leverage technology-enabled workflows to help streamline submissions and support a more efficient prior authorization process. Discover more in our Prior Authorization brochure.
How Do I Become Eligible for the Gold Card Program of Prior Authorizations?
Eligibility for the Gold Card program requires providers to demonstrate a consistent history of accurate and compliant prior authorization submissions.
Insurers grant “Gold Card” status to practices with high accuracy and low denial rates, allowing them to bypass prior authorization requirements for certain services. This helps reduce administrative work and supports more timely care delivery.
Advantum Health supports providers strengthen approval consistency and stay current with payer requirements which supports their eligibility for programs like Gold Card status. Learn more about Gold Cards and prior authorization.
What Are the Most Common Reasons for Prior Authorization Denials?
The most common reasons for prior authorization denials include incomplete documentation, incorrect coding, and failure to meet medical necessity criteria.
Other issues, such as using out-of-network providers or missing deadlines, also contribute to rejected requests. Each denial not only delays patient care but also impacts provider revenue and administrative costs.
At Advantum Health, our team works with providers to help minimize denials by promoting accurate submissions and payer-specific compliance from the start. See how Advantum combats claim denials.
What Does Gold Card Program Mean for Prior Authorization?
The Gold Card program in prior authorization allows select providers to bypass certain prior authorization requirements based on a strong record of accuracy and compliance.
It recognizes providers with consistent approval histories, helping reduce administrative work for both payers and practices. Gold Card programs are designed to improve efficiency and support patient access to needed care.
At Advantum Health, our experts help providers strengthen approval consistency and stay aligned with payer requirements – supporting eligibility for programs like Gold Card status.
What is the Difference Between Medical and Pharmacy Prior Authorizations?
The difference between medical and pharmacy prior authorizations is that medical prior authorizations apply to services and procedures, while pharmacy prior authorizations apply to prescription drugs.
Medical authorizations cover imaging, surgeries, or therapies, whereas pharmacy authorizations focus on high-cost or specialty medications. Both are used by payers to control costs and confirm that treatments meet clinical criteria.
Advantum streamlines both medical and pharmacy authorization workflows through automation and expert guidance, helping providers reduce administrative delays and support timely care. Learn how we simplify prior authorization.
Maximize Your Revenue Potential
Our AI-powered, outsourced RCM delivers the speed, accuracy, and cash flow your current process might be missing. Submit the form for a free workflow analysis and see how we stack up against your vendor or in-house billing.
Give us a call
502-861-5629
Email us at
info@advantumhealth.com