You will get Prior Authorization & Referral Services
Project details
This project provides Prior Authorization and Referral Management services for healthcare providers to ensure timely insurance approvals and smooth patient care delivery. It includes complete handling of prior authorizations starting from insurance eligibility verification, identifying requirements, preparing and submitting requests, and continuous follow-up with payers until approval or resolution.
The service involves working on major payer platforms such as Availity, as well as insurance-specific portals like UnitedHealthcare (UHC), Aetna, Cigna, and other commercial and government payers. All submissions are prepared with accurate documentation and compliance with payer guidelines to reduce delays and denials.
It also includes referral coordination between primary care providers and specialists, ensuring proper documentation, communication, and timely processing. The focus is on reducing turnaround time, minimizing authorization delays, and improving approval success rates.
Overall, this service streamlines administrative workflows, reduces provider workload, ensures compliance with HIPAA and payer requirements, and supports faster, more efficient patient care delivery.
The service involves working on major payer platforms such as Availity, as well as insurance-specific portals like UnitedHealthcare (UHC), Aetna, Cigna, and other commercial and government payers. All submissions are prepared with accurate documentation and compliance with payer guidelines to reduce delays and denials.
It also includes referral coordination between primary care providers and specialists, ensuring proper documentation, communication, and timely processing. The focus is on reducing turnaround time, minimizing authorization delays, and improving approval success rates.
Overall, this service streamlines administrative workflows, reduces provider workload, ensures compliance with HIPAA and payer requirements, and supports faster, more efficient patient care delivery.
Purpose
BusinessIndustry
Medical & PharmaceuticalLanguage
EnglishWhat's included
| Service Tiers |
Starter
$50
|
Standard
$150
|
Advanced
$300
|
|---|---|---|---|
| Delivery Time | 3 days | 2 days | 1 day |
Basic Photo Editing | - | - | - |
Organize & Classify/Tag Files | - | - | - |
Formatting & Clean Up | - | - | - |
Project Management Support | - | - | - |
Travel Planning | - | - | - |
Frequently asked questions
About Khawar
RCM & AR Specialist | Medical Billing, Credentialing & EDI Enrollment
Muridke, Pakistan - 7:28 am local time
⚡️ Optimize Revenue Cycles, 💰 Maximize Collections, and Streamline Your Practice’s Financial Performance. Partner with a Results-Driven Healthcare Revenue Specialist.
🏆 Upwork Rising Talent
💎 Free Consultation on Medical Billing, Credentialing & RCM
✅ End-to-End Solutions: AR Management, Clean Claims, Denial Resolution, Credentialing & Contracting
📅 Same-Day Consultation Available
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### 𝐌𝐘 𝐀𝐑𝐄𝐀𝐒 𝐎𝐅 𝐒𝐏𝐄𝐂𝐈𝐀𝐋𝐈𝐙𝐀𝐓𝐈𝐎𝐍:
• End-to-End Revenue Cycle Management (RCM)
• Accounts Receivable (AR) Follow-ups & Aging Reduction
• Medical Billing & Coding (ICD-10, CPT, HCPCS)
• Insurance Claim Submission & Payment Posting
• Denial Management & Appeals Handling
• Insurance Eligibility & Benefits Verification
• **Provider Credentialing, Enrollment & Contracting**
• **CAQH Profile Creation, Maintenance & Attestation**
• **PECOS Enrollment (Medicare)**
• **Medicaid & Commercial Payer Enrollment**
• **Provider Contracting & Rate Negotiation Support**
• **State License Application & NPI Registration**
• EDI Enrollment (ERA, EFT, Clearinghouses)
• Clearinghouse Rejections & Resolution
• Patient Billing & Collections Optimization
• HIPAA Compliance & Documentation
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### 𝐓𝐎𝐎𝐋𝐒 & 𝐏𝐋𝐀𝐓𝐅𝐎𝐑𝐌𝐒:
• Kareo
• AdvancedMD
• Athenahealth
• eClinicalWorks
• NextGen
• Practice Fusion
• Office Ally
• Availity
• Waystar
• Change Healthcare
• **CAQH ProView**
• **PECOS (CMS Portal)**
• **NPPES (NPI Registry)**
• **Medicare & Medicaid Portals**
• **Payer-Specific Portals (UHC, Aetna, BCBS, etc.)**
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### 𝐌𝐘 𝐄𝐒𝐓𝐈𝐌𝐀𝐓𝐄𝐃 𝐓𝐈𝐌𝐄𝐅𝐑𝐀𝐌𝐄𝐒:
📄 Claim Submission: 24 – 48 hours
📊 AR Follow-up & Denials: Ongoing (Daily/Weekly Reports)
📑 Credentialing & Enrollment: 30 – 120 days (payer-dependent)
🔄 EDI Enrollment (ERA/EFT): 7 – 14 days
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✅ If you're aiming to reduce denials, accelerate reimbursements, and ensure smooth provider onboarding, I’m ready to help.
💎 Approach: Accuracy, Compliance, Efficiency, and Transparency
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### 𝐌𝐘 𝐖𝐎𝐑𝐊𝐈𝐍𝐆 𝐇𝐎𝐔𝐑𝐒:
• 40 Hours/Week
• Monday – Saturday
• Flexible with Global Time Zones
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### 🔑 𝐊𝐄𝐘𝐖𝐎𝐑𝐃𝐒:
RCM, Medical Billing, AR Specialist, Credentialing, Provider Enrollment, CAQH, PECOS, NPI, EDI Enrollment, ERA, EFT, Contracting, Medicare Enrollment, Medicaid Enrollment, Denial Management, Claims Processing, Payment Posting, Insurance Verification, HIPAA Compliance, EMR, EHR, Healthcare Revenue Cycle, Practice Management
Steps for completing your project
After purchasing the project, send requirements so Khawar can start the project.
Delivery time starts when Khawar receives requirements from you.
Khawar works on your project following the steps below.
Revisions may occur after the delivery date.
Requirement Gathering & Insurance Details Collection
Collect complete patient demographics, insurance information, provider details, and required authorization or referral type. Verify payer and service details before starting the process.
Prior Authorization / Referral Submission & Follow-up
Submit prior authorization or referral requests through payer portals (Availity, UHC, Aetna, Cigna, etc.). Monitor status regularly and follow up with insurance companies until approval or resolution is received.