Services · Prior authorizations
An unauthorized study is free work
Sleep studies, bronchoscopies, biopsies, high-cost diagnostics — the services payers gate hardest are the ones pulmonology runs on. Here's what a real authorization workflow looks like, so you can tell which billing providers actually have one.
Compare free quotesWhy this is the first thing to ask about
A sleep study performed before authorization clears isn't delayed revenue — it's usually no revenue, and an appeal you'll probably lose. Meanwhile, authorizations that sit in a queue delay diagnosis for patients who came in short of breath. Both failure modes trace to the same root: nobody owns the authorization desk.
The workflow standard
What to demand from any biller's prior-auth process
Flag at scheduling. The payer's authorization requirement for that CPT and plan is checked before the appointment is confirmed, not after.
Same-day submission. Clinical documentation packaged to the payer's stated criteria the first time, not in back-and-forth rounds.
Tracked and escalated. Every pending auth on a worked list with payer reference numbers; stalled requests escalated by phone, not left to portals.
Peer-to-peer prep. When a payer pushes back, your physician gets the case summary and the specific criteria at issue, not a cold call.
Ask a prospective biller to walk you through each step for a hypothetical in-lab sleep study. Fumbling here predicts denied studies later.
Prior authorization, answered
Which pulmonology services usually need prior authorization?
Most commonly: in-lab sleep studies and titration, home sleep tests under some plans, bronchoscopy with biopsy, chest CT, pulmonary rehabilitation programs, and home oxygen. It varies by payer and plan — the workflow must confirm per payer, never assume.
What does a practice have to provide?
The order and clinical notes. Everything else — payer criteria, forms, submission, follow-up, and telling your scheduler the moment a study clears — is the biller's job.
Ask who owns the auth desk
Get competitive quotes, then make each biller walk you through a sleep-study authorization step by step.
Compare free quotes
Takes 30 seconds. Free for practices. No obligation.
Free for practices. No obligation.