Operational support where your team needs it
AuthorizeRx supports defined administrative workflows for pharmacies and healthcare practices. We start with the work itself: what comes in, what needs to happen, who can act, and when an exception must return to your team.
Our portfolio is organized around two major divisions: Long-Term Care Pharmacy Operations and Physician and Private-Practice Services, with particular attention to independent offices and pain-management practices. Retail and specialty pharmacy support sits within our pharmacy division.
Division 1: Long-Term Care Pharmacy Operations
Build support around the recurring queues in your long term care pharmacy, including admissions, approved data entry, refill tracking, insurance follow-up, document handling, and facility communication. Your procedures establish the boundaries, and your licensed team retains clinical review and control.
Best place to start: A recurring queue with clear source information and a defined pharmacy reviewer.
Refills, synchronization and communications
Support intake and permitted prescription entry; track refills and medication synchronization; maintain authorized auto-refill records and exceptions under pharmacy procedures. Benefits, PA and claim follow-up connect with patient, prescriber and facility communications. Nonclinical adherence outreach follows approved scripts and escalates medication questions to the pharmacy.
Pharmacist-led programs and operational records
Proposed administrative modules include scheduling and records for pharmacist-led MTM, immunization and counseling; inventory alerts; purchase-order preparation for pharmacist approval; delivery reconciliation; and order-record administration. Staff do not independently purchase, dispense or change medication.
Audit-response preparation and internal checks
Organize requested records for PBM audit responses and perform scoped completeness checks across claims, inventory and operational records. Authorized reviewers resolve discrepancies and approve responses. Administrative preparation does not guarantee an audit outcome.
Retail and specialty pharmacy support
Discuss administrative support for prescription intake, coverage follow-up, prior authorization tracking, document requests, and other assigned worklists. Specialty requirements vary, so the service scope is reviewed against your operation before an engagement is agreed.
Best place to start: Intake or follow-up work that repeatedly interrupts the pharmacy team.
Division 2: Physician and Private-Practice Services
Discuss administrative workflows such as referral tracking, insurance checks, authorization coordination, document follow-up, and approved scheduling tasks. Clinical questions and medical decisions remain with the practice.
Best place to start: A worklist with unresolved requests, repeated handoffs, or inconsistent follow-up.
Billing prior authorization and accounts receivable support
Organize assigned billing worklists, track payer responses, follow up on outstanding information, and make the next action visible. Your team sets billing policies and retains responsibility for clinical content, coding decisions, and financial approvals.
Best place to start: An aging worklist where status, ownership, or the next step is unclear.
Patient access through claim submission
Coordinate registration, benefits and referrals; support approved charge entry and qualified coding review; prepare assigned claims and handle clearinghouse rejections under practice instructions. Coding questions and clinical documentation gaps go to qualified reviewers. Coverage and authorization do not guarantee payment or establish medical necessity.
Payments, denials and accounts receivable
Scope payment posting and ERA/EOB reconciliation, underpayment review, AR aging and payer follow-up. Prepare denial worklists, corrected claims and appeal materials; track deadlines and practice approvals. Patient statements, practice-approved payment-plan coordination and reporting remain within client billing policies and financial authority.
Practice operations and patient access
Proposed support includes remote reception, scheduling and reminders, phone/portal/fax routing, chart and referral coordination, and telehealth administration. Use approved scripts, permissions and escalation routes; urgent symptoms and clinical questions require qualified clinical handling.
Provider records and documentation support
Evaluate credentialing, enrollment, recredentialing, revalidation, CAQH and hospital-privilege documentation support. Transcription, scribing, qualified coding review and records audits require suitable qualifications, consent, secure systems and clinician review; final clinical notes remain with the responsible clinician.
Clinician-led programs: readiness review required
CCM/RPM administration may include enrollment logistics, document routing and appointment follow-up. Telephone intake and escalation must follow approved protocols. Clinical triage, interpretation, advice, diagnosis, prescribing and treatment decisions remain with qualified clinicians. Administrative support alone does not establish clinical competence, program eligibility or billability.
Clinical authority stays with licensed professionals
Clinical medication reviews, therapeutic optimization, MTM assessments, dispensing and counseling remain with authorized pharmacists or clinicians. Your team retains clinical, billing-policy and financial decisions. We define permitted administrative work, review requirements and pause-and-escalate rules for each setting; we do not assume all-system integrations, specialist competence or guaranteed results.
A defined engagement rather than an open-ended task list
Before work begins, we agree on the workflow, permitted actions, systems, access, hours, escalation contacts, and reporting. We review how the process is working before adding more responsibilities.
Not sure which service fits
Describe the queue or recurring task that needs attention. We will use that as the starting point for a scope discussion.