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Service RCM Audit & Revenue Leakage Analysis … bottlenecks, delivered as a findings report with prioritized recommendations. Revenue leakage rarely shows up as one big problem. It is the visit that was completed but … Service Denial Management … appeal. Practices with recurring denials for eligibility, authorization, medical necessity or modifiers. Anyone already using Revelrex Medical Billing who wants the full cycle … Service Medical Billing … Claims are scrubbed for payer rules, eligibility, authorization and referral requirements, modifiers and place of service before submission. Claim submission Electronic … Service Credentialing & Provider Enrollment … details, TIN, group NPI, W-9, locations and a signed authorization allowing Revelrex to act on the practice's behalf with payers. Your dashboard lists exactly what is …

Page Payer change alerts Email alerts when a payer changes a policy, a fee schedule or a prior authorization rule.

Lookups Prior Authorization Lookup Enter a CPT or HCPCS code and a payer type to see whether prior authorization is commonly required, what payers check, what to send and how long the decision takes.

Billing and denials · 3 pages Prior Authorization Log A printable log for tracking every authorization request from the first call to the last visit, with instructions and the fields explained.

Payer Operations · Sep 13, 2026 · 9 min Prior Authorization for Drugs: Pharmacy vs Medical Benefit and Step Therapy A drug denied at the pharmacy counter and a drug denied before an infusion are two different problems with two different rulebooks. Here is how prior authorization for drugs works under the pharmacy benefit and the medi… RCM Operations · Jul 21, 2026 · 8 min Prior Authorization Turnaround Tracking: The Log That Wins Appeals Since January 1, 2026, Medicare Advantage, Medicaid managed care and Marketplace plans must decide most prior authorizations within seven days, or 72 hours when expedited. Practices that log every request against those … Payer Operations · May 18, 2026 · 9 min Prior Authorization for Imaging: What Radiology Benefit Managers Check First Most imaging prior authorization requests are decided by a radiology benefit manager, not the health plan, and the decision follows a fixed set of questions. We explain who EviCore, Carelon, Evolent and HealthHelp are, … Denial Management · Apr 3, 2026 · 8 min Prior Authorization Appeals Under the New 7-Day and 72-Hour Timeframes Since January 1, 2026 Medicare Advantage and Medicaid managed care plans must decide standard prior authorization requests in seven days, expedited requests in 72 hours, and state a specific reason for every denial. Her… Payer Operations · Aug 18, 2026 · 8 min Five Months to the January 1, 2027 Prior Authorization API Deadline On January 1, 2027, Medicare Advantage, Medicaid managed care and Marketplace plans must offer a FHIR prior authorization API under CMS-0057-F, and the insurers' 2025 pledge to standardize electronic prior authorization… Industry News · Jun 24, 2026 · 7 min The Insurer Prior Authorization Pledge, One Year In: What Actually Changed A year after more than 50 health plans pledged to cut prior authorization, the industry reports an 11 percent reduction, UnitedHealthcare has promised much larger cuts, and the CMS rule now sets deadlines for government… Industry News · May 15, 2026 · 9 min AMA Prior Authorization Survey, May 2026: 13 Hours a Week and How to Count Yours The AMA released its latest prior authorization physician survey on May 13, 2026: 13 hours of physician and staff time a week, 40 percent of practices with dedicated staff, and only a third of physicians expecting the i… Industry News · Mar 30, 2026 · 7 min WISeR at Three Months: Prior Authorization in Traditional Medicare in Six States Since January 1, 2026 the CMS WISeR model has applied prior authorization to a short list of services in traditional Medicare in Arizona, New Jersey, Ohio, Oklahoma, Texas and Washington. Here is how it works, what prac…