What gets lost between the order and the approval
Prior authorization tracking for medical practices starts after the clinician orders a service. Someone has to check whether the plan requires authorization, send the request with the right records, answer the payer’s questions, record the approval and make sure the visit happens inside the approved dates. In a small office, each of those steps often lives in a different person’s memory or inbox.
Gateway puts all of it in one place. We keep the list current and chase the open items, so your staff can see at a glance which requests need attention today.
What the tracker holds
Each request has a single entry with the facts a scheduler, biller or clinician would need.
- Patient, payer and plan, with the member number used on the request
- The service, product or equipment ordered, and the ordering clinician
- Date the request was sent and how (portal, fax or phone)
- The payer’s reference number
- Records sent, and anything the payer has asked for since
- Current status: not started, submitted, pending, more information requested, approved, denied or under appeal
- Approved units or visits, and the approved date range
- Expiration date
- The next step and who owns it
A request without a reference number or an owner is treated as not yet handled.
Missing items and payer information requests
Most delays come from an incomplete request. The payer wants a recent note, measurements, results of an earlier treatment or a signed order, and the request waits until it arrives.
We compare each request against what that payer asks for, list what is missing and send the clinician or staff member a specific ask. When a payer sends an information request, we log it with its due date and gather the records from the chart. Clinical answers come from the record or from the clinician. We do not write them.
Status checks and decisions
Pending requests are checked on a regular cycle through the payer’s portal or by phone, where the practice has authorized us to do so.
When a decision arrives, the entry is updated and the people who need to know are told. Scheduling learns the patient can be booked. Billing gets the authorization number for the claim. If the request is denied, the clinician gets the stated reason and the deadline for a peer-to-peer review or appeal.
Expirations, units and renewals
An approval has edges. It covers a set number of visits or units within a date range, and care that runs past either one may not be covered.
We track both. As an authorization nears its end date or its last approved unit, we flag it early so the clinician can decide whether to request more. This matters most for ongoing care, such as serial wound treatments, advanced wound care products and durable medical equipment, where plans often approve a limited course and require a new request to continue.
Who does what
The clinician decides what to order and whether it is medically necessary. The clinician, or staff the practice designates, confirms the clinical content of a request and handles any peer-to-peer conversation. Requests go out under the practice’s name.
Gateway keeps the tracker, assembles supporting records, follows up with payers and reports status. We can help identify services that commonly need authorization, but the practice confirms each payer’s current rules. An approval does not guarantee payment, so the tracker feeds your medical billing process and, when a claim still denies, claims follow-up.
Tools and automation
The tracker can live in your existing system, a shared worklist or a purpose-built tool. Practices with higher volume can ask about AI-assisted prior authorization workflows, which help identify services needing authorization and assemble records for staff review. For a do-it-yourself starting point, see our guide to prior authorization tracking for small practices.
Getting started
Use the practice support inquiry form or call 314-325-0126. The form takes contact details only.
We start by asking how requests are handled now: who sends them, where approvals are recorded and which payers or services cause the most rework. A sensible first scope is one service line or one payer. Once the list is reliable there, the practice decides whether to extend it.
Common questions
Does Gateway submit prior authorization requests for us?
The service is built around tracking: what was requested, what is missing, where it stands and when it expires. We can also assemble the records a request needs. Whether Gateway staff or your own staff enter the request with the payer is agreed at the start, and it always goes out under the practice’s name with clinical content the clinician stands behind.
What happens when a payer denies a request?
The denial is logged with the payer’s stated reason and the deadline to respond. The ordering clinician decides what to do next: a peer-to-peer review, an appeal, a different order or no further action. If the clinician chooses to appeal, we gather the records and track the appeal like any other open request.
Does an approved authorization mean the claim will be paid?
No. An authorization confirms the payer agreed the service met its criteria in advance. Payment still depends on eligibility on the date of service, the claim matching what was approved and the payer’s other rules. Carrying the authorization number, dates and units accurately onto the claim removes one common reason for denial.
How do you handle a patient whose coverage changes mid-treatment?
A plan change usually means the old authorization no longer applies. When your staff or the patient reports new coverage, we mark the existing entry, open a new one for the new payer and flag upcoming visits so scheduling and the clinician can decide how to proceed while the new request is pending.