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For healthcare providers and practice managers, our free audit / consultation request form is the simplest way to connect with our team. Whether you have questions about our services, need clarification on specific offerings, or would like to explore customized solutions for your practice, we appreciate you to please fill the form. Please feel free to share any inquiries, concerns, or details you would like us to review—nothing is too small or too complex. Once submitted, our specialist team will come back to you and schedule a dedicated consultation at your convenience. We are committed to supporting you, addressing your questions with clarity, and ensuring you feel fully informed and confident moving forward.

info@caremedox.com

(607) 225 5002

30 Days Free Revenue Audit

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Terms & Conditions

Effective Date: 12/1/2025
Company: CareMedox, LLC.
Website: www.caremedox.com

By using this website, you agree to follow these Terms & Conditions. If you do not agree, please discontinue use immediately.

  1. Use of Website

    This site is provided for informational use regarding CareMedox services. Misuse, disruption, or unauthorized access is prohibited.

  2. No Medical or Legal Advice

    Information displayed here is not medical, legal, or financial advice. Providers should consult qualified professionals for decision-making.

  3. Intellectual Property

    All logos, content, graphics, and materials belong to CareMedox. Reproduction or distribution without permission is not allowed.

  4. Third-Party Links

    External links may be provided for reference. We are not responsible for third-party content or privacy practices.

  5. Limitation of Liability

    CareMedox is not liable for any damages arising from website use, including:

    1. Service interruptions
    2. Incorrect or outdated information
    3. Technical errors

    Use of this site is at your own risk.

  6. Privacy & Data Protection

    By using our site, you acknowledge that data you submit may be used according to our Privacy Policy. CareMedox complies with HIPAA where applicable for services provided to healthcare clients.

  7. Changes to Terms

    We reserve the right to update these Terms at any time without notice. Continued use of the website constitutes acceptance of changes.

  8. Governing Law

    These Terms are governed by the laws of the United States and the State in which CareMedox is headquartered.

Contact Information

For any questions or concerns regarding terms and conditions please reach out to us by:

Email: info@caremedox.com

WhatsApp Us: +1 (607) 225 5002

I have read & agree to the Terms & Conditions

Privacy Policy

Effective Date: 12/1/2025
Company: CareMedox, LLC.

CareMedox is committed to maintaining the confidentiality, integrity, and security of all personal, business, and healthcare information entrusted to us. This Privacy Policy outlines how we collect, use, and protect information when you visit our website or engage in our services.

  1. Information We Collect

    1. Personal Information
      1. Name
      2. Email address
      3. Phone number
      4. Business or practice details
    2. Usage Data
      1. IP address
      2. Browser type
      3. Pages accessed
      4. Cookies
    3. Protected Health Information (PHI)

      If you become a CareMedox client, we may receive PHI exclusively for medical billing or RCM purposes, including:

      1. Patient demographics
      2. Insurance details
      3. Diagnosis & procedure codes
      4. Claims & billing information
  2. HIPAA Compliance

    For all services involving PHI, CareMedox:

    1. Follows HIPAA privacy and security standards
    2. Signs Business Associate Agreements (BAA) with clients
    3. Implements safeguards to protect PHI
    4. Restricts access to authorized personnel only
  3. How We Use Information

    We may use your information to:

    1. Provide medical billing, credentialing, and RCM services
    2. Respond to inquiries
    3. Improve website functionality
    4. Send business-related updates
    5. Maintain compliance with HIPAA and other regulations

    We never sell or share PHI or customer information for advertising.

  4. Data Protection & Security

    CareMedox maintains administrative, physical, and technical safeguards including:

    1. Encrypted data storage
    2. Secure transmission methods
    3. Access controls & audits
    4. HIPAA-trained staff
  5. Sharing of Information

    Information may be shared only with:

    1. Authorized personnel involved in your services
    2. Insurance payers
    3. Clearinghouses
    4. Credentialing entities
    5. Compliance-required agencies

    We do not sell, rent, or trade your data.

  6. Your Rights

    You may request to:

    1. Access your information
    2. Correct inaccurate information
    3. Request deletion where permitted
    4. Obtain a copy of your records

    To exercise these rights, contact us.

  7. Changes to This Policy

    We may update this Privacy Policy periodically. Updates become effective upon posting.

Contact Information

For any questions or concerns regarding terms and conditions please reach out to us by:

Email: info@caremedox.com

WhatsApp Us: +1 (607) 225 5002

I have read & agree to the Terms & Conditions

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Authorization & Referral Management Services

Reduce Denials
Accelerate Approvals
Protect Your Revenue

In today's healthcare landscape, prior authorizations and referral management have become major administrative burdens for practices of all sizes. Delays, incomplete documentation, and payer-specific rules often result in denials, postponed treatments, and lost revenue.
At CareMedox, we take complete ownership of your authorization and referral workflow — ensuring quick approvals, real-time follow-ups, and clean submissions so your providers can focus on patient care, not payer paperwork.

25%+
Revenue Acceleration Rate
30%
Faster Reimbursement
56%+
Denials Reduction Rate

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Why Authorization & Referral Management Matters?

Prevent Claim Denials

A large percentage of denials come from missing, incorrect, or delayed prior authorizations. We eliminate these issues with proactive verification and clean submissions.

Improve Patient Care Coordination

Faster approvals mean fewer treatment delays and better clinical outcomes.

Accelerate Reimbursements

Approved authorizations ensure that claims move through the system smoothly, improving overall cash flow.

Lighten Administrative Burden

Your staff no longer needs to spend hours on hold with insurance companies — we handle everything for you.

Stay Compliant With Payer Rules

We stay up to date with all insurance requirements, including Medicare, Medicaid, and commercial plans.

Our Authorization & Referral Services

Below is a complete suite of services we manage for your practice:

01

Prior Authorization Management

We complete, submit, and manage all prior authorization requests across all insurance payers, including:

  • CPT/HCPCS code verification
  • Medical necessity documentation
  • Payer-specific guideline checks
  • Real-time follow-up until approval
  • Notification to providers and staff
Click here to see specialties we support
02

Outbound & Inbound Referral Management

We manage both incoming and outgoing referrals for your practice.

For outgoing referrals:

  • Prepare and submit referral requests
  • Attach clinical notes, labs, imaging, or required documents
  • Coordinate with specialists
  • Track referral status

For outgoing referrals:

  • Verify insurance coverage
  • Handle scheduling communications
  • Make sure patients are authorized and ready to be seen
03

Eligibility & Benefits Verification

Before any authorization is submitted, we confirm:

  • Active insurance status
  • Plan benefits
  • Deductibles, co-insurance, co-pay
  • Procedure-specific coverage
  • Prior authorization requirements
  • Referral requirements

This prevents unnecessary denials and ensures patients know what to expect financially.

04

Documentation Collection & Submission

We prepare and submit all documents required by payers, including:

  • Progress notes
  • Imaging results
  • Lab reports
  • Treatment plans
  • Clinical summaries
  • Provider credentials & NPI details

Clean documentation = faster approvals.

05

Clinical Justification Support

Our team reviews payer policies and confirms that your clinical documentation meets medical necessity requirements.

We prepare detailed clinical justification summaries when needed.

06

Real-Time Follow-Ups

We do daily follow-ups with payers until the authorization is:

  • Approved
  • Denied (and ready for reconsideration)
  • Pending (with required action)

You receive updates immediately through your preferred communication channel.

07

Authorization Tracking & Reporting

You get full transparency with:

  • Daily/weekly status reports
  • Authorization verifications
  • Approval/denial trends
  • Turnaround time metrics
  • Alerts on expiring authorizations
08

Appeals & Reconsiderations

When a payer denies an authorization, we:

  • Analyze the reason
  • Collect additional clinical documentation
  • Submit appeals
  • Follow payer reconsideration guidelines

We don’t stop until every possible option is exhausted.

Our Seamless Process

Patient Intake & Order Review

We receive the request (from provider, staff, EHR, or fax) and verify details.

1

Eligibility & Benefit Check

We confirm coverage, requirements, and referral needs.

2

Documentation Collection

We gather all medical records needed for the authorization.

3

Prior Authorization Submission

We complete payer forms and submit clean, accurate requests.

4

Follow-Up & Tracking

Our team consistently follows up until approval is obtained.

5

Approval Notification

You receive immediate updates, including authorization number, validity period, and approved services.

6

Claims Support

Approved authorizations are synced with billing to ensure clean claims and reduced denials.

7

What You Gain

Faster approvals

Fewer denials

Increased reimbursements

Reduced provider & staff workload

Better patient experience

Strong compliance with payer rules

Elimination of administrative bottlenecks

Who We Help

We support

Solo providers
Group practices
Multi-location practices
Labs & imaging centers
Urgent care centers
Specialty clinics
Telehealth providers
Home health agencies

Across all specialties and all U.S. states.

Is This Service Right For You?

Choose our Authorization & Referral Services if your practice wants to:

  • Reduce prior auth-related denials
  • Speed up patient scheduling
  • Improve operational efficiency
  • Eliminate long insurance wait times
  • Ensure every service is authorized before claims are submitted

Ready to Streamline Your Prior Authorization & Referral Workflow?

Let CareMedox handle the paperwork — while you focus on patient care.

Frequently Asked Questions

Authorization and referral management services ensure that required approvals and referrals are obtained from insurance payers before services are rendered. This process helps prevent claim denials, delays, and unexpected patient responsibility.
Many commercial and government payers require authorizations or referrals, including Medicare Advantage, Medicaid plans, BCBS, Aetna, Cigna, UHC, and specialty-specific plans. Requirements vary by payer, procedure, and diagnosis.
We manage authorizations for diagnostic tests, imaging, procedures, surgeries, DME, therapies, specialty visits, hospital services, telehealth, and outpatient treatments, depending on payer rules.
Yes. CareMedox supports medical, dental, hospital, and specialty authorization and referral workflows, following payer-specific guidelines for each service type.
We verify authorization requirements in advance, submit accurate documentation, track approval status, and confirm authorization numbers before services are provided. Our team actively follows up, escalates when needed, and documents every request until a final payer decision is received—significantly reducing denial risk.
Yes. We coordinate incoming and outgoing referrals, ensure correct provider information, verify network status, and confirm payer requirements to support seamless patient care.
Yes. CareMedox provides regular updates, tracking logs, and clear communication so your team always knows the status of authorizations and referrals.
Yes. Authorization and referral management can be provided as a standalone service or integrated into full RCM, billing, or specialty support packages for maximum efficiency.
Click here to view all our offers
Yes. When clinically necessary, we submit and track urgent or expedited authorization requests according to payer policies and timelines.
Our team follows payer-specific guidelines, documentation standards, and required timelines to keep your practice compliant and audit-ready.
Yes. CareMedox provides authorization and referral management services across all U.S. states. We are also a full RCM management company offering charge entry, claim submission and validation, rejection and denial management, AR follow-up, payment posting, and more.
Click here to view all our offers
Simply contact CareMedox, and our team will assess your authorization volume, specialties, and payer mix. We’ll design a customized workflow to meet your needs.