Non-clinical work only
The team supports the administrative process. Clinical judgment and care decisions stay with licensed staff.
Prior authorization support
Prior authorization follow-up, without pulling staff off patients.
A dedicated bilingual team in Colombia gathers the documents, submits requests through payer portals, checks status and follows up until each authorization is decided, inside your systems. Your clinicians keep medical necessity and every clinical decision.
Medical practices · Specialty clinics · Revenue cycle teams
You
- Medical necessity
- Clinical documentation
- Peer-to-peer reviews
- Appeals strategy
Optimus
- Checking whether an authorization is needed
- Gathering required documents
- Payer portal submissions
- Status follow-up
- Recording outcomes
Non-clinical work only, inside your approved systems.
How the authorization queue runs.
A documented path from the order to the decision, with a defined handoff whenever clinical input is needed.
Check the requirement
For each scheduled service, the team checks the payer's rules to see whether authorization is required.
Gather the packet
The team collects the orders, notes and codes the payer asks for from your EHR, and requests anything missing from your staff.
Submit
Requests are submitted through the payer portal or the channel your practice uses, under your practice's access.
Follow up
Pending requests are checked on a set cadence, and additional-information requests are routed to your staff.
Record the outcome
Approvals, reference numbers and denials are recorded where your team expects them, and scheduling is notified.
Escalate
Denials, peer-to-peer requests and anything needing clinical judgment go to the person you name.
The team supports the process. Your clinicians make the decisions.
| Optimus can execute | Your team retains |
|---|---|
| Eligibility and requirement checks | Medical necessity and clinical criteria |
| Document gathering from approved systems | Clinical notes and their content |
| Portal submission and status checks | Peer-to-peer reviews |
| Recording approvals and reference numbers | Appeals decisions |
| Notifying scheduling of outcomes | Whether to proceed without authorization |
Documented practices, stated precisely.
Your systems
Work happens inside client-approved systems and payer portals. Optimus systems are not the primary storage location for patient data.
Training and confidentiality
Personnel receive internal HIPAA training and sign confidentiality agreements. Remote-work security requirements are established.
Business Associate Agreement
Optimus is willing to sign a BAA for applicable engagements. Optimus does not currently hold independent healthcare-compliance certifications or third-party audits.
Frequently asked questions
Scope, coverage hours and pricing are confirmed in your proposal.
Can prior authorization be outsourced?
The administrative work can: checking requirements, gathering documents, submitting requests, following up and recording outcomes. Medical necessity, clinical documentation, peer-to-peer reviews and appeals strategy stay with your licensed staff.
Does the team work inside our EHR and payer portals?
Yes, inside the systems and portals you approve, with the access you grant. Optimus systems are not used as the primary storage location for patient data.
Will Optimus sign a BAA?
Optimus is willing to sign a Business Associate Agreement for applicable engagements. Optimus does not currently hold independent healthcare-compliance certifications or third-party compliance audits.
What hours does the team cover?
North American business-hour schedules aligned with Eastern, Central or Pacific time. Other coverage is scoped separately.
Can you also handle eligibility checks and referrals?
Yes. Eligibility follow-up, referral coordination and medical-record requests are part of the non-clinical work Optimus supports, and are often combined with authorizations in one queue.
Bring us the authorization queue.
Show us how authorizations move through your practice today. We will map the steps, the systems and the handoffs to your clinical staff, and tell you what a dedicated team can take on.