Prior authorization outsourcing services

Prior authorization services
staffed by a dedicated team

Prior authorization services cover the work of getting a payer’s approval before a procedure, test, or drug: eligibility checks, submissions, status follow-up, and peer-to-peer scheduling. Practices and billing teams outsource it to a dedicated team from Digital Minds BPO, in our Naga City, Philippines offices, at an estimated $1,260 to $2,100 a month per specialist, billed hourly.

Book a consultation Request a proposal

Pick a time that suits you, straight from our calendar.

Prior authorization specialists working insurance portals and patient records on an office floor in Naga City

Savings: 70%; Up to. US benchmark: $3,500 to $7,000 a month for a US-based agent
Retention: 94%; Client retention
Partnership: 4.7yrs; Average client partnership
Since: 2010; Serving clients from Naga City

Clients we have served

Scope

Prior authorization services, task by task. What your specialist does all day.

Prior authorization is a payer’s approval, required before it will cover a procedure, test, or drug. Health plans, Medicare Advantage, and Medicaid programs require it to check medical necessity and cost. It delays care and payment because the request waits in a review queue until the payer decides.

Your job description sets the exact tasks; this is the usual shape of the work.

Intake

Before anything goes to the payer, your prior authorization specialist checks eligibility and benefits and confirms whether the procedure, test, or drug needs an authorization at all. Then they pull the payer’s criteria and collect what the request needs from your chart: visit notes, imaging, prior treatments. Missing items go back to your clinical staff as a short list, so nothing leaves half-complete.

Submission

Your specialist submits new requests through payer portals such as Availity, CoverMyMeds, and eviCore, and records each one in your EHR, whether that is Epic, Athenahealth, eClinicalWorks, NextGen, or another platform on our list. Each submission carries the criteria and documents gathered at intake. Retro authorizations follow the same path, started after the service where the payer allows it.

Follow-up

The wait is where requests stall. Your specialist tracks every open request and checks whether it is approved by reading the payer portal or calling the payer, then logs each answer where your team can see it. They chase any request that goes quiet or stalls on a missing document. The reports we send show what is open, what is approved, and what needs your attention.

Denials

When a request is denied, your specialist records the reason, tracks the appeal deadline, assembles the appeal packet from your documentation, and resubmits. If the payer offers a peer-to-peer, they book the slot and send your physician the file. The physician takes the call and makes the clinical argument. That part stays with you. The payer’s reply is logged the same way as every other status.

Straight answers

What your team controls, and what the payer decides

Can you guarantee approval?

No, and be wary of anyone who does. The payer makes every determination. We control the quality of the request: complete documents, the right criteria, and steady follow-up. Your clinicians control whether the care meets the payer’s medical-necessity test.

How fast are approvals?

Payers set their own review times, and they vary by plan and request type, so we promise none. We agree turnaround targets for our own tasks, such as sending a complete request, in writing with each client.

What happens when a request is denied?

We record the reason, build the appeal packet from your documentation, resubmit, and book the peer-to-peer call if the payer offers one. Your physician takes that call. If the denial turns on clinical judgment, the decision to appeal stays with you.

Do you take a share of what gets approved?

No. We staff the role at an hourly rate, take no percentage of collections, and promise no denial-rate outcome.

Who owns what

Who owns what on every request

Outsourcing prior authorization works when the split is clear on day one.

Duty	Your practice	Your dedicated team
Clinical documentation	Writes and signs the clinical notes	Requests missing notes; writes no clinical content
Medical-necessity judgment	Your clinicians decide	Checks the payer’s criteria; makes no clinical call
Peer-to-peer call	Your physician takes the call	Books the slot and prepares the file
Submissions and follow-up	Sets priorities and grants system access	Submits, tracks, and chases until a determination
Hiring, training, and QA	Interviews and chooses the team	Recruits, trains, coaches, and checks quality
Daily supervision	Sets targets and reviews the reports we send	Supervises daily, keeps procedures current, and checks quality

Specialties

Specialties we support. Hired to your job description.

Prior authorization services look different by specialty. These are request types a dedicated team can be hired to handle, alongside our other healthcare BPO and medical billing roles.

Imaging and radiology

MRI, CT, and PET requests that need clinical notes attached.

Oncology and infusion

Drug regimens and infusion visits that renew on a schedule.

Orthopedics and surgery

Procedure requests with imaging and prior-treatment notes in the file.

Cardiology

Stress tests, echo studies, and device procedures.

Behavioral health

Therapy and psychiatric visit authorizations, plus renewals.

Specialty pharmacy

Drug authorizations sent through CoverMyMeds and payer forms.

Durable medical equipment

Equipment orders with prescriptions and supporting notes.

Physical therapy and rehab

Visit limits tied to the plan of care, renewed as limits near.

Why the Philippines

Outsource prior authorization to the Philippines

Prior authorization outsourcing services run well from the Philippines when four questions get specific answers.

An agent on a live call at a workstation in our Naga City office — **Naga City**Philippines

Time zone. We schedule your team to your coverage hours, normally inside the hours payer phone lines are open. The night differential for US hours is already in the rate, so they carry no premium.

English. Candidates take skills testing that covers communication, and you interview the shortlist by video before anyone is hired.

Data security. Your specialist works only from our Naga City offices, inside your systems, over VPN where you need it. Nobody works from home, and we sign a Business Associate Agreement on request.

Management. We supervise the team every day, at no extra charge. If you want to hire a prior authorization specialist in the Philippines, we own recruiting, training, and supervision.

You choose the people. We run the team.

Recruiting, training, and supervision stay with us; the clinical decisions stay with you.

How it works

From first call to first submission

From signed agreement and deposit to team start: 15 to 30 days, depending on role complexity and team size.

Step 01Together
Talk
We go through your payers, specialties, volume, and systems, then recommend a team size and tier mix.
Your partShare your payers, systems, and request volume.
Step 02Your side
Agree
We send a proposal with team size and rates. You sign the agreement and pay a one-month security deposit, applied to your final month. Recruitment starts when the deposit clears.
Your partSign the agreement and pay the deposit.
Step 03Together
Hire
We source, screen, and test candidates for your job description. You interview the shortlist by video and choose your team.
Your partInterview the shortlist and choose your team.
Step 04Together
Train
Your team starts in our Naga City office. We train them on your processes and tools, and the first 5 days of training are free.
Your partGive system access and share your procedures.
Step 05Our side
Run
We supervise daily, at no extra charge. You set targets and review the reports we send, and we review performance with you at 30, 60, and 90 days.

Pricing

Prior authorization pricing. Three tiers, one estimated range.

Prior authorization sits on our Medical Billing and Healthcare RCM rate card. Every figure is an estimate, billed hourly on actual hours worked.

Prior authorization specialist

Medical Billing and Healthcare RCM rate card

Entry · 0 to 1 years$7.50/hr$1,260 est./month
Mid · 1 to 3 years$9.50/hr$1,596 est./month
Expert · 3 to 6 years$12.50/hr$2,100 est./month

Est. Monthly · Billed Hourly, on actual hours worked.
No setup or recruitment fees. First 5 days of training free.
Shared Team Leader and Project Manager included at no extra charge.

How prior authorization is priced

Providers price prior authorization services three ways: per request, per dedicated team member, or as a share of collections. Per-request pricing suits uneven or low volume. A dedicated team member’s cost does not rise with request volume, so the cost per request falls as volume rises. We bill dedicated roles hourly on actual attendance and take no share of collections. Some providers publish hourly offers at or below our Entry rate, so price alone should not decide it.

Teams start at 3 agents. Three Entry seats come to an estimated $3,780 a month, a higher starting point than one hire. It buys a shared Team Leader, a Project Manager, daily supervision, quality checks, and teammates who work from the same documented procedures. Ask any provider what its quote leaves out. Ours leaves out your EHR and portal licenses: we provide people and workstations, not software.

In-house vs dedicated

In-house coordinator vs a dedicated team

Prior authorization services can sit with a coordinator you hire or a team we run.

Item	In-house coordinator	Dedicated team
Hourly wage	$22.08/hr national median (BLS, May 2025, released May 15, 2026). Wage only.	$7.50, $9.50, or $12.50/hr by tier, estimated
Benefits and overhead	You carry them	Payroll, HR, hardware, and IT support sit in the rate
Hiring and start	You post, screen and interview alone	We source and screen; you choose. Team start in 15 to 30 days
Management	Falls to your office manager	Daily supervision from our side, at no extra charge
Coverage hours	Your coordinator’s working day	Scheduled to your coverage hours; night differential in the rate
Team structure	Rests on one person’s habits	Teams start at 3, working from shared, documented procedures
When someone leaves	You restart hiring and training	We replace them at no recruitment cost

The in-house figure is the national median hourly wage for medical secretaries and administrative assistants (BLS 43-6013), the closest occupation we found. Wage only: it excludes benefits, payroll tax, overhead, recruiting, and turnover.

Proof

Clients stay. Here is the record.

Client retention rate: 94%
Average client partnership: 4.7 yrs
Agents on a single-client team: 50 to 100+
Serving clients from Naga City: Since 2010

People who stay learn your payers, your forms, and your physicians’ habits.

Clients we have served

P&G
B2B telesales
We have supported P&G’s distributor network with B2B telesales.
Petron
Outbound call center
We have served Petron with an outbound call center for database management.
Philippine Bureau of Customs
Government call center
We ran the official call center for the Philippine Bureau of Customs from 2021 to December 2023.

From our clients

Dwayne-Miller-Outsourcing-testimonial — Dwayne MillerCEO of SaleEgg

We came to Digital Minds BPO with a customer service turnover problem in the US. What surprised me most was how quickly the team became part of our family.

Jake WilliamsPresident, Make A Fort LLC

We have run sales, outbound, and government call center programs for these clients. Your prior authorization team gets the same hiring, training, and supervision.

Security

HIPAA and how we protect patient data

HIPAA Privacy and Security training for every employee who handles healthcare data
A Business Associate Agreement, signed on request
Patient data handled only inside our Naga City offices, never from home
Biometric fingerprint access to production floors, with no personal phones, USB drives, or laptops on them

Company-owned, hardened desktops that connect to your systems by VPN where you need it
A non-disclosure agreement signed by every employee
NBI and police clearance for every hire, plus employer and reference checks
Philippine Data Privacy Act (RA 10173) compliance, with a certified Data Protection Officer

We do not hold a SOC 2 report today, and we do not hold ISO 27001 certification. If your vendor policy requires a SOC 2 report now, we are not the fit yet. We never call ourselves “HIPAA certified,” because no such certification exists.

Choosing a partner

How to choose a prior authorization company. Use it on everyone.

Five questions to put to every provider you speak to, including us.

The 5-Point Prior Authorization Partner RubricDigital Minds BPO
Criterion	Question to ask	What to look for
01What is promised	Question to askWhat do you guarantee, in writing?	What to look forPromises about the provider’s own work. Treat a guaranteed approval or denial rate with care: the payer decides.
02How it is priced	Question to askPer request, per person, or a share of collections? What does the quote leave out?	What to look forA rate you can see before you sign. Ask about software licenses, training time, and minimum team size.
03Systems and portals	Question to askWhich EHRs and payer portals can your team work in?	What to look forNamed systems, not “all of them.” Ask who holds the logins and who pays for licenses.
04Request types	Question to askHow will you train the team on our payers and request types?	What to look forA training plan built on your payers and your procedures. Ask how the team handles missing documents and denials.
05Data protection	Question to askWill you sign a BAA, and where does patient data live?	What to look forA signed BAA, trained staff, controlled facilities. A badge with no report behind it is not evidence.

FAQ

Prior authorization questions, answered straight

How much do prior authorization services cost?

A dedicated specialist costs $7.50, $9.50, or $12.50 an hour by tier, an estimated $1,260, $1,596, or $2,100 a month, billed on actual hours worked. When you outsource prior authorization to us, teams start at 3 agents, so three Entry seats come to an estimated $3,780 a month. There is no per-authorization, setup, or recruitment fee.

How long does it take to send a prior authorization, and to get a decision?

Sending depends on how quickly your documents reach us. The decision depends on the payer, the plan, and the request type, so we promise no number. What we control is how fast a complete request leaves your team and how often we chase it. We agree turnaround targets for those tasks in writing with each client.

What should I look for in a prior authorization company?

Look for promises about the provider’s own work, never about the payer’s decision. Ask for named systems and portals, a price you can see, a signed BAA, and a clear split of who owns what. Our five-point rubric works on every provider, including us.

Is a prior authorization virtual assistant the same as a dedicated team?

The work is the same: submissions, follow-up, and denials. Ours is done by a dedicated team in our Naga City offices, never from home, with daily supervision. For a wider role, see our medical virtual assistant team.

Which EHRs and payer portals can your team work in?

Your team works inside your systems, from our offices, over VPN where you need it. This role commonly uses Epic, Athenahealth, eClinicalWorks, and NextGen, with Availity, CoverMyMeds, and eviCore for payer work. The logins stay yours: you provide the tools, and we provide the people and workstations.

Do you contact the patient?

Yes, if your in-house staff do. Your team follows your own workflow, so it contacts patients when your coordinators would. Our healthcare billing scope includes patient statements and billing inquiries, and any outreach about an authorization is agreed before the team starts. Clinical questions go back to your staff.

Can I start with one person?

No. Teams start at 3 agents, and this role has no single-seat exception. The team is what makes the rate work: supervision from a shared Team Leader and a Project Manager, quality checks, and teammates who work from the same documented procedures. If one hire is all you need, an in-house coordinator may fit better.

What if a team member is not the right fit?

We coach and retrain first. If that does not fix it, we replace the person at no recruitment cost, and you interview the replacement candidates yourself. Our replacement target is 15 to 30 days from notice. A vacant seat records zero hours, so you pay nothing for the gap.

Proposal

Request a proposal. Rates, team size, and a start plan.

Tell us your payers, specialties, and request volume.

You interview and choose your teamNo setup or recruitment feesNo obligation

My advice for anyone considering Digital Minds BPO: start small where you have the greatest need, then expand as you see what’s possible.

Jake WilliamsPresident, Make A Fort LLC

Next step

Your clinicians should see patients. Let a dedicated team chase the payers.

Book a consultation to scope your prior authorization services, your payers, and a team that fits.

US +1 302 501 7702 · UK and Europe +44 736 049 6832 · Australia +61 495 033 200 · New Zealand +64 781 07413

Book a consultation