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Prior Authorization Services

Magellan Solutions handles prior authorization for hospitals, medical and dental practices, specialty clinics, and pharmacies losing staff hours and revenue to payer requirements. Our teams run the full authorization cycle — benefit verification, clinical documentation, submission, daily follow-up, and appeals — built around your systems, your documentation standards, and HIPAA-conscious workflows. Treatment decisions stay with your providers; the payer-facing work comes to a team that has supported healthcare organizations since 2005.

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1-800-371-6224

At a Glance

Best For Hospitals, medical & dental practices, specialty clinics, and pharmacies managing high prior authorization volume
Core Support Benefit verification, documentation & medical necessity, payer submission, status follow-up, denials & appeals
Delivery Philippines-based delivery inside your EHR/EMR, pharmacy, and practice management systems

A missed authorization is a delayed treatment and stalled revenue

Handing prior authorization to a team that treats it as clerical data entry is a real risk — one that shows up as denied claims, care that waits, and patients who lose confidence. Most PA denials aren't caused by inappropriate treatment; they come from documentation that doesn't carry the specificity, context, or clinical justification a payer's review demands.

 

Get it wrong and the work comes back — reworked claims, appeals, days added to AR.

Getting it right the first time takes people who know payer rules and medical necessity criteria, not a generalist back office.

Put your authorization work with a team that has supported healthcare providers since 2005.

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Our Prior Authorization Services

Magellan Solutions manages the authorization process end to end, so approvals move faster and your clinical staff get their day back.

Submission & Documentation

The single biggest lever on first-pass approval is documentation built to each payer's rules. We verify benefits, assemble packages against that payer's medical necessity criteria, and route each request through the right channel — portal, fax, or ePA — so it lands correctly the first time instead of costing days in rerouting.

Follow-Up & Status Tracking

The single biggest lever on first-pass approval is documentation built to each payer's rules. We verify benefits, assemble packages against that payer's medical necessity criteria, and route each request through the right channel — portal, fax, or ePA — so it lands correctly the first time instead of costing days in rerouting.

Denials & Appeals Management

The single biggest lever on first-pass approval is documentation built to each payer's rules. We verify benefits, assemble packages against that payer's medical necessity criteria, and route each request through the right channel — portal, fax, or ePA — so it lands correctly the first time instead of costing days in rerouting.

Why Healthcare Organizations Outsource Prior Authorization

Every hour your clinical and front-desk staff spend in payer portals, on hold, or reworking a denied request is an hour not spent on patients. Prior authorization is exactly the kind of work that outsources well — process-driven, payer-rule-heavy, and measurable — and the burden only grows as more procedures and specialty drugs fall under authorization.

Cost Reduction

Philippine delivery runs 40–60% below onshore, freeing budget for care instead of PA overhead

Higher First-Pass Approvals

Payer-specific documentation built to medical necessity criteria, so fewer requests come back

Faster Turnaround

Approvals move quickly so patients start treatment sooner and schedules stay full

Lower Days in AR

Authorization-related payment delays prevented before they ever reach billing

How Our Prior Authorization Process Works

A structured workflow that replaces fragmented internal steps with a dedicated team — so nothing slips and you always know where each authorization stands. Clinical decisions stay with your providers throughout; we handle everything that happens between the decision and the approval.

An infographic illustrating a structured, 6-step prior authorization workflow that manages the administrative process between a provider's clinical decision and payer approval. The horizontal flow progresses through: 1. Eligibility & Benefit Verification to confirm active coverage. 2. Documentation & Medical Necessity Review to align with payer criteria. 3. Payer Submission routed through portal, fax, or ePA. 4. Proactive Follow-Up & Tracking with daily payer checks. 5. Approval Logged in Your System directly into the EHR or PM system for billing. 6. Denials & Appeals managing peer-to-peer reviews and resubmissions, with a directional loop feeding back into the main workflow. A footnote emphasizes that clinical decisions remain with the healthcare providers throughout the entire process.

Who We Support

Providers

End-to-end PA management for practices, medical groups, and hospitals — benefit verification, clinical documentation, submission, follow-up, and denial appeals, handled inside your EHR so scheduled care doesn't get held up.

Pharmacies

Specialized support for pharmacy authorizations and appeals — specialty drug approvals, formulary and medical necessity requirements, and denial overturns, so prescriptions get filled and patients get their medications faster.

Compliance and Data Security, Built In

Prior authorization touches protected health information and directly affects reimbursement, so trust is only worth extending to a partner that can show its safeguards. Magellan Solutions operates under certified security standards, documented confidentiality policies, and business-continuity planning that keep protected health information protected.
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Certified Standards

Magellan holds ISO 27001, PCI-DSS, and HIPAA certifications — the recognized benchmarks for information security, payment data, and protected health information. See our certifications.

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Controlled Data Access

Network and IT infrastructure sits in secured, IT-only locations. Workstations and servers are password-protected across access levels, and physical data-entry points are disabled to prevent unauthorized transfer.

Enforceable Confidentiality

Every employee signs a confidentiality agreement before job assignment — subject to Philippine law and prosecutable on breach. Access to your data is limited to the team working your account.

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Continuity You Can Count On

Continuous data backup with off-site copies, a co-location plan with a backup center outside a 10-mile radius, and power-blackout protection — so patient support doesn't stop when circumstances change.

Want to know more?

Explore our services further by filling out the form below, and we'll reach out to you soon!

    Our Onboarding Process

    Requirements Setting

    1

    1

    Call center outsourcing

    Recruitment

    2

    2

    Agent Training

    3

    3

    Campaign Incubation

    4

    4

    Campaign Go Live

    5

    5

    Frequently Asked Questions

    FAQ
    What is prior authorization outsourcing?
    Prior authorization outsourcing is delegating the payer-facing side of authorizations — checking whether a service or drug requires approval, verifying benefits, assembling and submitting clinical documentation, following up with payers, and appealing denials — to a specialized partner, so clinical staff stay focused on care.
    Do clinical decisions stay with our providers?
    Yes. We never make medical decisions. Your clinicians decide on treatment, and our team turns that decision into a complete, payer-ready authorization request — escalating cases like peer-to-peer reviews back to your team when needed.
    Can your teams work in our EHR and pharmacy systems?
    Yes. We're platform-agnostic and train to your systems — EHR/EMR, pharmacy, and practice management — rather than moving you onto ours.
    How does outsourcing reduce denials?
    Most denials come from incomplete or non-specific documentation, not inappropriate care. Our specialists know payer-specific medical necessity criteria and build each submission to meet them upfront — improving first-pass approval and cutting costly rework.
    Do you handle both provider and pharmacy prior authorizations?
    Yes. We run dedicated programs for each — end-to-end PA management for provider practices, and specialized authorization and appeals support for pharmacies, including specialty drug approvals.
    How is prior authorization different from benefits verification?
    Benefits verification confirms that a patient has active coverage and what they'll owe; prior authorization gets the payer's approval for a specific service or drug before it's delivered. They're sequential steps — Magellan provides both, so coverage checks and authorizations run as one workflow rather than two handoffs.
    Is outsourced prior authorization HIPAA compliant?
    Yes — our teams operate under HIPAA-conscious workflows: signed BAAs, controlled system access, and audit-ready documentation of every authorization and payer interaction.

    We'd be happy to walk you through your options.

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      Toll Free: 1 800 371 6224

      US:  +1 650 204 3191

      UK: +44 8082 803 175

      AU: +61 1800 247 724