How GladMedRCM Simplifies Prior Authorizations & Referrals to Keep Care Moving and Revenue Flowing

Few administrative tasks create more friction in a healthcare practice than prior authorizations and referral requirements. They delay care, frustrate staff, and if missed, often result in claim denials and lost revenue. In fact, prior auth issues account for up to 16% of all denials, and they’re a leading cause of delayed treatments across specialties.

At GladMedRCM, we remove that burden from your team with our comprehensive Prior Authorizations & Referrals service, ensuring approvals are secured quickly and accurately — before they impact patient care or payment.

Taking the Complexity Off Your Plate

Our team manages every step of the prior authorization process, including:

• Verifying if the service or medication requires authorization
• Gathering required documentation and provider notes
• Submitting requests via payer portals, forms, or phone/fax
• Tracking progress and following up until a decision is reached

Whether it’s a high-cost drug, imaging study, outpatient procedure, or specialist referral, we take ownership from start to finish — so your staff doesn’t have to.

Proactive Follow-Through That Prevents Delays

We don’t just submit and wait. Our specialists:

• Log all auth reference numbers
• Set internal follow-up checkpoints to ensure no request stalls
• Escalate for peer-to-peer reviews when needed
• Coordinate appeals if an auth is denied

We aim to have authorizations approved before the patient arrives, avoiding last-minute cancellations, reschedules, or financial confusion.

Built-In Expertise on Every Payer

Authorization rules are complex, inconsistent, and constantly changing — but we stay ahead of them.

Our team maintains a live database of payer-specific requirements, including:

• Which CPT codes trigger authorization after a certain number of visits
• Plans that require proof of conservative therapy
• Referral requirements for specialists
• Authorization timeframes and submission methods

This ensures your requests are clean, complete, and aligned with the latest payer criteria — reducing the risk of rejections or resubmissions.

Saving Your Team Time (and Sanity)

Instead of tying up your staff on hold with insurers or wrestling with payer portals, we give them back hours each week. That’s time they can spend with patients — not paperwork.

We’ve helped practices:

• Cut prior auth-related denials by up to 40%
• Accelerate turnaround times
• Free up front-office and clinical staff
• Keep treatment plans on track

Fighting for Approvals When It Matters

Even when an authorization is initially denied, we don’t stop there. Our team prepares and submits clinical appeals and coordinates peer-to-peer discussions, backed by the documentation that matters most.

In fact, more than 80% of appealed prior auth denials can be overturned with proper follow-up — and we know how to do it right.

From Oncology Drugs to MRI Referrals — We’ve Got You Covered

Whether it’s a specialty medication, diagnostic imaging, rehab therapy, or a referral to a subspecialist, we handle the pre-approvals so you don’t have to.

No more scrambling at the last minute. No more lost revenue to missing paperwork. Just smarter, faster approvals that keep your revenue cycle intact and your patients on schedule.

Turn Prior Auths From a Bottleneck Into a Breeze

With GladMedRCM handling your prior authorizations and referrals, your staff can stay focused on care — and your claims stay clean, accurate, and payable.

Ready to stop losing time and revenue to missed authorizations? Let’s talk