Prior Authorization Support That Reduces Delays and Denials

Verisma manages prior authorization requests, payer follow-up, denials, and determination updates so providers can stay focused on patient care.

When Prior Authorizations Stall, Care Gets Delayed

Prior authorization is one of the most burdensome administrative workflows in healthcare. Incomplete documentation, missed submissions, payer-specific requirements, and repeated follow-up can delay care, frustrate patients, increase denials, and pull staff away from higher-value work.

60k

Annual Prior Authorizations Processed

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A Better Way to Manage Prior Authorizations

Verisma Prior Authorization manages the full authorization cycle on behalf of providers — from reviewing orders and confirming payer-specific requirements, to submitting requests, following up on determinations, and resolving denials. We work inside your existing EHR and payer portals to reduce administrative burden, improve approval rates, and keep care moving forward without delays.

How Prior Authorization Works

Review Orders & Documentation

Verisma receives the order or medication request, confirms payer-specific authorization requirements, and validates that the clinical information on file meets submission criteria before the request moves forward.

Submit for Determination and Follow Up

The Verisma team submits the authorization request to the payer and continues follow-up until a determination is made.

Update the Chart & Notify the Right Parties

Once a determination is received, Verisma uploads the approval or outcome to the chart and can notify the patient, staff, pharmacy, or other parties as needed.

Manage Denials and Appeals

If an authorization is denied, Verisma helps review alternatives, supports appeals, and can facilitate peer-to-peer preparation between the provider and payer.

More Than Submission: Full-Cycle Authorization Support

Handle a Wide Range of Authorization Types

Supports authorizations for diagnostic imaging, medications, and procedures
Manages infusions, injections, surgeries, and medications
Supports DME and preventive exam authorization workflows
Handles HEDIS-related preventive exam use cases
Adapts to a wide range of payer and clinical requirements

Work Within Your Existing EHR and Payer Portals

Works within existing EHR and payer portal environments
Eliminates the need for a separate technology platform
Reduces IT overhead and implementation complexity
Aligns workflows with current practice operations
Supports seamless coordination across systems and teams

Support the Full Process, Not Just Submission

Supports payer follow-ups and authorization status management
Assists with denial disputes and resolution workflows
Coordinates peer-to-peer review activities when needed
Keeps patients informed throughout the authorization process
Manages next-step communication and follow-up actions
Provides end-to-end workflow support beyond initial submission

“The facility has eliminated the daily paperwork burden, enabling faster patient care with clear clinical decisions. OrthoEast leverages people-powered technology to oversee the entire process, including
necessary follow-ups.”

Orthopaedics East & Sports Medicine Center

FAQs

Common Questions About Prior Authorization

How does Verisma fit my prior authorizations workflow?

Verisma Prior Authorization picks up where submission ends. Our U.S.-based teams monitor authorization status across payers, follow up on pending requests, manage escalations, and track denials – so your staff isn’t chasing down outcomes. We integrate into your existing scheduling and clinical workflow to ensure authorizations are secured before the patient ever arrives.

What kinds of authorizations can Verisma help obtain?

Verisma can help obtain authorizations for diagnostic imaging, standard and specialty medications, procedures, infusions, injections, surgeries, DME, and preventive exams tied to HEDIS metrics. In practice, if it needs an authorization, Verisma can usually help manage it.

Can Verisma help with denials and peer-to-peers?

Yes. Verisma reviews denied authorizations, helps identify alternative medications or next steps when appropriate, and can support the provider with the policies, procedures, and clinical information needed for appeals and peer-to-peer discussions.

How does Verisma keep the process moving after submission?

Verisma follows up on submitted authorizations until a determination is made, then updates the chart and can notify the patient, staff, pharmacy, or other parties of the outcome. This helps reduce the burden on internal teams and keeps the next step in care moving.

What types of organizations are the best fit for this service?

Verisma Prior Authorization is best suited for ambulatory, specialty, and clinic-based organizations managing high authorization volume or complex payer relationships. If your staff is spending significant time on hold, tracking pending requests manually, or struggling to keep up with denial timelines, this service is built for your environment.

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