Navigating the Prior Authorization Process | BrainCheck

Prior authorization is a necessary—but often frustrating—part of working with insurance companies. Delays and denials are common, but understanding your options can help you avoid unnecessary roadblocks. Here are the three main methods to obtain prior authorization:

1. Payer Portal – The Standard Route 

Submit requests and upload documents directly through the insurer’s portal. You’ll get a tracking number for real-time updates, which helps you stay informed throughout the process.

2. Fax – The Traditional Way

Download, complete, and fax the insurer’s form with supporting documentation. This method can be risky—faxes may get lost or go unconfirmed, which could force you to start over.

3. Call – The Direct Approach

Reach out to the insurance company by phone. Be prepared to wait on hold and always document the call (agent’s name, date, time, and reference numbers). If needed, the insurer may review the call to support your case.

Avoiding Denials: A Few Pro Tips

Prior authorization isn’t just a formality—missing it can lead to denials with little chance of retroactive approval. For CPT codes like 96136, 96138, and 96132, look under behavioral health rather than medical in some payer portals. Also, check if your provider’s specialty might be exempt from prior authorization requirements.

Bottom Line:

Stay organized, double-check requirements, and don’t hesitate to follow up. In the world of medical billing, preparation and persistence pay off. Need help? Reach out—I’m here to support you through the process.

If you need further assistance or guidance on Prior Authorization, feel free to reach out for support.

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