Authorization & Referral Management



Authorization & Referral Management

One of the most prominent causes of revenue loss is the failure to get a referral or authorization before performing any procedure. Medical billing reimbursement rates have shown that the most common denial is not receiving a referral or approval before performing the procedure.

Referrals and pre-authorizations are not required for all services or procedures, but if they are needed and are not acquired, reimbursement may be at risk.

Medical providers and billing companies must get certification numbers when reimbursement is required.

Authorization is the process by which the insurance carrier authorizes a medical service. These numbers must be used by providers/billing companies on claims submitted for payment, resulting in authorization and referral numbers.

In the Medical Billing Cycle, WiseMed Solutions considers and manages Authorization and Referral as a particular project because of its time and cost.


We have Authorization Specialists who deeply understand payer contractual requirements and functionalities. We find, verify eligibility, get insurance benefits, and check pre-certification, authorization, and referral requirements through payer paperwork and research.

As your partner in health care, we ensure accurate and comprehensive submission of prior authorizations and referrals to payers. We promise to notify everyone of any changes or implementations that might impact your financial well-being.

The following are some of the benefits of our authorization and referral services:

  • Keep a record of the steps taken to get authorization and referral.
  • A practice management system is used to manage work.
  • Staff communication about authorization denials and approvals.