Prior Authorization Outsourcing to the Philippines
An offshore authorization desk that submits, chases and documents every request, so procedures stay on the schedule and your clinical staff stay with patients.
John Maczynski, CEO · Ralf Ellspermann, CSODesigned for programs scaling from 5 – 500+ FTEs
What does a prior authorization team in the Philippines actually take off your plate?
Everything between the order and the decision. The team checks whether a service needs authorization, assembles the clinical documentation, submits through the payer portal, fax or phone line, follows up until there is a decision, and records the outcome in your practice management or EHR system. Licensed nurses review the clinical side; trained specialists handle submission and follow-up. Your providers only step in for peer-to-peer reviews, which the team schedules for them. It sits inside your revenue cycle, after eligibility and benefits verification and before claims go out.
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Authorization delays move procedures, frustrate patients and create avoidable denials. The fix is a dedicated team that works every request to a decision and documents each step.
Who outsources authorizations, and where cases get stuck.
Oncology, cardiology, orthopaedics and imaging, where most orders need authorization and delays move procedures.
High volume across departments; the need is a central desk that clears cases before scheduled dates.
Tight schedules where a missing authorization means a cancelled slot.
Running authorizations for many clients, each with different payers and systems.
How an outsourced authorization workflow runs
A good authorization desk works from a queue, not an inbox. Each order becomes a case with a due date set by the appointment, and the team works the queue in date order so the nearest procedures are cleared first.
Hand-offs are written down. Your schedulers know when a case is cleared, your providers know when a peer-to-peer is booked, and your billing team sees the authorization number on the encounter before the claim is built.
What to measure in an authorization program
Measure the desk on outcomes your schedulers and billers feel, not on calls made. Agree the definitions before go-live so the scorecard matches your own reports.
Security and compliance for authorization work
Authorization work touches protected health information on every case, so the provider must run it under a signed business associate agreement with HIPAA controls you can audit. Ask for current SOC 2 Type II or ISO 27001 reports, named access to each payer portal and EHR, and a clean-desk, no-device production floor.
Our HIPAA-compliant support page lists the controls in full, and the compliance and security guide explains how to test them before you sign.
Indicative 2026 rates, priced by role, fully loaded per hour.
Ask each vendor to price the same mix of specialists and nurse reviewers against your monthly authorization volume, by payer. Rates confirmed per engagement.
Scope my authorization desk →Generic BPO vs. a vetted authorization desk.
Where a generic back office and a vetted authorization team differ on the work that protects your schedule.
Four jobs the authorization desk runs every day.
Most practices and health systems outsource the whole authorization cycle, but the work splits into four distinct jobs with different skills.
Confirm whether the CPT code, payer and plan need authorization, using payer rules and your own history, and open a case the moment an order is placed.
Pull notes, imaging and lab results from the EHR, match them to the payer’s criteria and submit through portals such as Availity or payer-specific sites, by fax or by phone.
Chase pending cases on a fixed cadence, answer requests for more information and escalate anything that threatens the scheduled date.
Schedule peer-to-peer reviews for your physicians, prepare the case summary and draft first-level appeals for denied requests.
See the full revenue cycle →Two friction points that make outsourced authorizations miss the date that matters.
Both are measurable and both can be tested in a short pilot.
Where an outsourced authorization desk doesn’t fit.
Where prior authorization sits in the healthcare cluster
Authorization is one step in the revenue cycle. These are the pages on either side of it.
Requirement checks, clinical packets, payer follow-up, peer-to-peer scheduling and first appeals.
Eligibility and benefits checks that tell you whether the patient is covered at all.
Insurance verification →The end-to-end program from registration to payment posting, of which authorization is one part.
Revenue cycle management →Clear authorizations before the patient arrives.
Tell us your volume, payers and systems. John will bring a shortlist of vetted Philippine providers that already run authorization desks for US providers.
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What revenue cycle leaders ask before they outsource prior authorization.
Straight answers to the questions that decide an authorization engagement, from the principals who run them.
Can an offshore team submit prior authorizations in US payer portals?+
Do we need nurses on the team?+
How is protected health information kept secure?+
Will the team handle peer-to-peer reviews?+
How long does it take to stand up an authorization desk?+
Two Decades Building and Advising Award-Winning Philippine BPO Operations
Ralf grades Philippine providers on operating data, compliance evidence and leadership depth before any benchmark reaches this page.
View full bio →
Former Global EVP of the World’s Largest Contact Center · Four Decades of Outsourcing Experience
John reviews the pricing and contract architecture behind each program, keeping this page grounded in live vendor terms.
View full bio →Re-audited as rates, regulation and vendor capacity change. Every benchmark on this page is held to PITON-Global’s internal vetting standard.