Service
ServicePrior Authorization services for U.S. healthcare practices.
AI-driven prior auth submission, status checks, and peer-to-peer scheduling. Medonix's Prior Authorization service combines AI agents with senior AAPC- and AHIMA-credentialed operators and a written SLA tied to your collections, onboarded in 30 to 60 days with zero revenue disruption.
Why this matters
Why prior authorization is harder than it looks.
Prior authorization is the most resource-intensive workflow in U.S. healthcare, and the one where AI helps most. The work is highly repetitive (look up payer policy, gather documentation, submit, follow up), but it requires payer-specific rules and clinical context. Medonix runs prior auth with AI agents for submission and status tracking, escalating to credentialed staff for clinical-judgment reviews and peer-to-peer scheduling.
How it runs
The four-step prior authorization workflow.
Every engagement runs the same four-stage process. Volume, complexity, and specialty mix change. The structure does not.
- Step 01
Identify
Real-time check at scheduling whether a PA is required, per payer, per CPT, per place of service.
- Step 02
Submit
AI-driven submission with the right documentation packet attached. Most payers receive within minutes.
- Step 03
Track
Status checked daily until decision. Stalled requests escalated to a credentialed PA specialist.
- Step 04
Peer-to-peer
Peer-to-peer reviews scheduled and prepared for the provider with documentation summary in hand.
Specialties served
Specialty-engineered prior authorization playbooks.
Each specialty gets its own CPT/ICD logic, payer edits, and dedicated credentialed coding team. Drag to explore.
01 · SpecialtyCardiology
Catheterization lab billing, device codes, and complex E/M leveling.
See playbook
02 · SpecialtyOrthopedics
Joint replacements, modifier 59 surgical bundling, and DME workflows.
See playbook
03 · SpecialtyOb-Gyn
Global maternity packages, ultrasound, and in-office procedures.
See playbook
04 · SpecialtyPediatrics
Vaccine VFC accounting, well-child visits, and Medicaid heavy mix.
See playbook
05 · SpecialtyMental Health & Psychiatry
Time-based therapy codes, E/M + psychotherapy add-ons.
See playbook
06 · SpecialtyDermatology
High-volume excisions, Mohs surgery, and pathology coordination.
See playbook
07 · SpecialtyGastroenterology
Screening vs diagnostic colonoscopy and endoscopy bundling.
See playbook
08 · SpecialtyNeurology
EMG/EEG technical+professional splits and infusion billing.
See playbook
09 · SpecialtyOncology
Chemo administration, drug J-codes, and prior auth-heavy regimens.
See playbook
10 · SpecialtyFamily Medicine
Chronic care, AWV, and care management add-on codes.
See playbook
11 · SpecialtyInternal Medicine
CCM, RPM, and Medicare risk-adjustment-aware coding.
See playbook
12 · SpecialtyUrgent Care
S9088 facility fees, observation, and high-throughput claims.
See playbook
Frequently asked
Prior Authorization, answered.
The questions practice owners ask before they outsource this service. Book a 30-minute call if yours is not here.
Related services
Often combined with prior authorization.
Eligibility & Benefits Verification
Real-time eligibility, benefits, and copay determination before the visit.
See servicePatient Scheduling
Inbound, outbound, and recall scheduling with EHR-native calendars and bilingual coverage.
See servicePatient Statements & Collections
Compassionate patient billing with text/email reminders and payment plans.
See service
Talk to RCM
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See your projected revenue lift in 60 seconds, or talk to a senior RCM strategist now. No commitment. Same-day slots available.
- 30-day parallel-run guarantee
- Targets written into the contract
- HIPAA · SOC 2 Type II · HITRUST