Prior Authorization Outsourcing
Prior Authorization Services in the Philippines
Outsource Philippines™ gives your practice dedicated, HIPAA-trained prior authorization coordinators who prepare and submit requests, track every case to a decision, and follow up with payers before appointments are at risk. Your clinicians supply the medical details. The team works in your systems under a signed BAA and reports to you every week.
- 25+
- Years in Outsourcing
- 100%
- HIPAA-trained Before Go-live
- 90%
- Staff Retention over 12 Months
- 2–4 Wks
- To Set Up Your Team
What Your Team Handles
Prior Authorization Work We Take Off Your Staff
Your coordinators handle the paperwork, portals, and payer calls. Medical necessity stays with your clinicians.
Requirement Checks
Checks each order against payer rules to see whether an authorization is needed, before the visit or procedure is scheduled.
Request Preparation
Pulls demographics, codes, and the clinical notes your providers supply, and assembles a complete request so it is not returned for missing items.
Portal and Fax Submission
Submits requests through payer portals, utilization management vendors, CoverMyMeds, or fax, and records the reference number in your system.
Status Tracking and Follow-up
Works a daily queue of pending cases, calls payers on stalled requests, and escalates anything close to the appointment date.
Peer-to-peer and Appeal Support
Schedules peer-to-peer reviews for your providers and prepares appeal packets for denials. Your clinicians make the case.
Patient and Office Updates
Updates the chart and tells your schedulers when an approval lands, so visits are not cancelled or rescheduled at the last minute.
Workflow
A Tracked Queue, Not a Pile of Faxes
Every request gets an owner, a status, and a next follow-up date. Your coordinators work the queue in order of appointment date, so the most urgent cases move first.
We write an SOP with you for each high-volume payer, service line, and drug class, and update it when payer rules change.
- Requests Submitted per Day
- Average Days to Decision
- Approval and Denial Rates by Payer
- Cases at Risk Before the Appointment
Services
Roles Clients Add Next
Insurance Verification
Eligibility and benefits checks before the visit, so authorization needs are caught early.
Learn More →Medical Billing
Claims, payment posting, and denial follow-up after the visit.
Learn More →Virtual Medical Receptionist
Scheduling and patient calls that keep approved visits on the calendar.
Learn More →Compliance and Security
Non-clinical Scope, Written Down
Our coordinators do not decide medical necessity, write clinical notes, or speak for your providers. They gather what your clinicians document and submit it exactly as provided.
We sign a Business Associate Agreement before go-live. Staff are HIPAA-trained and use named logins you control, limited to the systems the role needs.
- Signed BAA Before Go-live
- HIPAA Training Before Any PHI Access
- Named-user Logins You Control
- Company-managed Devices Only
Accountability
How We Keep Quality High
Named Team Lead and Account Manager
A team lead runs the daily queue. An account manager owns your account and is your single point of contact.
QA Scoring Against Your Standards
We audit a sample of submissions for completeness and accuracy every week and coach on the gaps.
Weekly Performance Report
Volume, turnaround, approvals, and pending cases every week, so you see the same numbers we do.
Trained Backup Coverage
Cross-trained backups cover leave and sick days, so pending cases keep moving.
Replacement If Someone Leaves
If a team member leaves, we recruit and train a replacement.
Secure, Supervised Work
Your team works onsite in our supervised office on company-managed devices behind a firewall, not from home, with work tracked in WorQmate, our own monitoring platform.
How It Works
From First Call to Go-live in 2–4 Weeks
You stay informed at every step.
- 1
Day 1
Discovery Call
Tell us your specialty, monthly authorization volume, top payers, and the systems and portals you use.
- 2
After the Call
Written Proposal
Roles, headcount, hourly pricing, and start date in writing. Recruiting starts once you sign the Outsourcing Services Agreement and settle the security deposit.
- 3
Weeks 1–3
Screening and Interviews
We shortlist candidates with prior authorization or payer-facing experience where possible and test them on sample cases.
- 4
Weeks 2–4
Training and Go-live
We train on your SOPs, payers, and portals, ramp up under close supervision, and send your first weekly report.
Client Feedback
Why Clients Stay with Us
As always, we are very grateful to the entire FilWeb team for their dedication and excellent work. I only have good praises to sing. I am pleased to recommend you because I have no shortage of praises to sing for you guys.
Frequently Asked Questions
What Is Prior Authorization Outsourcing?
Prior authorization outsourcing means a dedicated outside team prepares, submits, and tracks authorization requests with payers for your practice. With Outsource Philippines™, that team works full time for you from our Philippine office, inside your EHR and payer portals, under a signed BAA.
Do Your Coordinators Make Clinical Decisions?
No. Your providers decide what is medically necessary and document it. Our coordinators collect that documentation, submit it as written, follow up with payers, and route any clinical question back to your staff.
Which Portals and Tools Can Your Team Use?
Your team works in the tools you already use, such as payer portals like Availity, utilization management vendor portals, CoverMyMeds for medications, your EHR, and fax queues. We train on your exact workflow before go-live.
How Much Do Prior Authorization Services Cost?
You pay an hourly rate for each dedicated, full-time coordinator that depends on the role and shift. Most clients save 60–70% compared with hiring locally. See our pricing page or request a written proposal.
Can One Coordinator Cover Several Specialties or Locations?
Yes, if volume allows. We size the team from your monthly request volume and payer mix, and we set up separate queues and SOPs for each location or service line so nothing gets mixed up.
Get Started
Ready to Clear Your Prior Authorization Backlog?
Tell us your volume, specialties, and payers. You get a written proposal.