Prior Authorization
Prior Authorization from Soft Home Global costs $1,900 per seat per month. That is one full time trained person, forty hours a week, working United States business hours inside your own system. One seat, one month, cancel any time.
Submitted before the date of service and chased through the payer's decision window.
Video transcript
- Prior authorization: files requests before the visit.
- Submits authorizations before scheduling, not after.
- Chases the payer's decision instead of waiting.
- Expiring authorizations flagged before they lapse.
What the seat actually does
- Authorizations submitted ahead of scheduling, not after
- Status chased rather than waited on
- Peer-to-peer reviews scheduled when required
- Clinical documentation gathered before submission
- Expiring authorizations flagged before they lapse
What it costs
$1,900
Per seat, per month, in US dollars. Full time, forty hours a week, on US hours — not per hour, not per claim, and never a share of your collections.
Compare against the other 21 roles →
Reselling seats to your own clients instead of staffing your own practice? What changes for a billing company.
The denial codes this seat works
7 codes, grouped the way the queue is worked rather than by number. Each one links to what causes it, the order to work it, and how to stop it recurring.
Worked by being taken back to the authorization
- CO-197 — Prior authorization absentThe payer required prior authorization for this service and cannot find one attached to the claim.
- CO-198 — Authorization limit exceededAn authorization exists. The problem is that you went past what it allowed — more units, more visits, or a longer date range than was approved.
- CO-15 — Authorization number missingThere is an authorization requirement here, and the number you sent is absent, wrong, or does not cover what was billed.
- CO-39 — Authorization already refusedThe authorization was asked for and refused, and the service was delivered anyway.
- CO-272 — Coverage guidelines not metThe service is covered in principle but this instance did not meet the program’s conditions.
- N54 — Claim does not match the authorizationThere is an authorization, and what was billed does not match what it covers.
Worked by being appealed with clinical documentation
- CO-273 — Guidelines exceededThe service is covered, but this instance went past a program limit: more visits, units or sessions than the guideline allows.
Working a denied claim costs $57.23 per denied claim in administrative time (source) and payers ultimately pay roughly 90% of claims even while using an initial denial to slow payment. The reason they sit is almost never that nobody knows how. It is that nobody has the hours.
How a seat starts
Every seat works from our office in Rawalpindi, Pakistan, on your hours, logged into your own system rather than ours. Some payer contracts and some state Medicaid programs restrict or require disclosure of offshore access — Medicare Advantage plans in particular require First Tier/Downstream/Related Entity oversight, which can mean disclosing us as a subcontractor — so check yours before placing a restricted queue on this seat. More on /security/.
You issue one named login. We sign the Business Associate Agreement before it is used. We agree the numbers you will judge the seat on, which you pick and you measure. Then we train for about a week on your workflow and the seat starts. Every Friday you get a written report of what was done, what the numbers were, and what went wrong.
Questions
How much does prior authorization cost?
$1,900 per seat per month. That is a full time person, forty hours a week, working United States business hours. Not per hour, not per claim, and not a percentage of what you collect.
Is there a minimum contract?
One seat for one month, cancellable with thirty days notice. There is no annual lock-in.
Do we have to change systems?
No. The work happens inside whatever you already use, through a named login you issue. We do not sell software and we do not route your data through anything of ours.
How quickly can a seat start?
A named person starts 14 to 30 days after the agreement is signed and the first month is paid, on a date agreed with you in writing. That includes about a week of training on your workflow, your payer mix and your system, which is not billed on top.
Next step
Try one prior authorization seat for a month
$1,900 for the month. If it does not earn its keep, cancel it. Twenty minutes on a call is enough to tell whether it fits.
Or write to ops@softhomeglobal.com