Pre-Authorization & Benefits Verification
Reduce auth denials and accelerate reimbursements with APEX RCM experts.
Set Every Claim Up for Success—Before Surgery Starts
Intraoperative neuromonitoring (IONM) billing success starts well before the first CPT code is ever submitted. At APEX IONM, our Pre-Authorization and Benefits Verification services act as the foundation for your entire revenue cycle—ensuring your cases are authorized, verified, and financially secure from day one.
Why This Step Matters
Pre-authorization issues are one of the top reasons IONM claims are denied or delayed. According to industry data:
- ~11.7% of IONM denials stem from missing or incorrect pre-authorizations*.
- 81.7% of these denials are overturned on appeal—but only if the right information is gathered upfront*.
- Proactive verification can cut appeal volume by nearly 50%, saving time and protecting cash flow*.
What We Do
✅ Real-Time Case Monitoring
We flag every scheduled procedure and initiate verification workflows immediately.
✅ Dual-Channel Verification
We verify coverage online and confirm key details directly via payer phone lines—avoiding hidden auth requirements.
✅ Authorization Workflow Integration
We work directly with scheduling and clinical teams to secure necessary documentation for timely pre-certification.
✅ Documentation Forwarding
We capture and store payer references, call logs, and coverage notes to back up future appeals and arbitrations.
✅ Continuous Eligibility Monitoring
We re-verify benefits when cases shift, reschedule, or get new CPT codes, ensuring claims match current payer expectations.
What Sets APEX Apart
End-to-End Workflow Coordination
Our pre-auth teams don’t work in a silo. We collaborate tightly with denial and appeal experts to ensure each claim is routed correctly, appeal-ready if needed, and fully documented from the start.
Strategy-Driven Verification
We think about collections before the surgery happens. Our goal isn’t just auth approval—it’s long-term claim success.
Built for Out-of-Network Complexity
Out-of-network claims often face tougher scrutiny. Our specialists are trained to navigate payer workarounds, ensuring compliance with laws like the No Surprises Act.
No Guesswork. No Gaps.
We verify every patient. We don’t “assume coverage.” And we don’t leave surgeons exposed to surprise denials or last-minute phone calls.
Result: Fewer Denials. Faster Reimbursements.
By starting strong, we reduce the need for rework, resubmissions, and time-wasting appeals, keeping your revenue flowing and your admin teams focused.
Ready to Transform Your Revenue Cycle?