RHEUMATOLOGY PRACTICE · Mid-Atlantic, US
Cut biologic prior authorization turnaround from 12 days to under 48 hours
A rheumatology clinic managing a high volume of biologic infusion and injection therapies needed to eliminate prior authorization delays that were stalling patient care and revenue.
Client: [Client Name Placeholder]
The Challenge
[Placeholder] Prior authorizations for high-cost biologics like Humira, Orencia, and Rinvoq were tracked manually across spreadsheets and payer portals, often taking up to two weeks to resolve. Expired authorizations led to delayed infusions, rescheduled appointments, and a growing volume of denied claims tied to lapsed approvals.
The Solution
[Placeholder] Unlimited Systems implemented an automated biologic pre-clearance workflow that cross-references payer formulary and step-therapy requirements at the time of scheduling, generates electronic prior auth requests, and proactively alerts staff 30 days before authorization expiration. Joint assessment scores and clinical documentation were linked directly to claims to support medical necessity.
The Results
12 to <2 days
Prior authorization turnaround time for biologic therapies
34%
Reduction in denials tied to expired or missing authorizations
21%
Increase in on-time infusion appointments
98.6%
First-pass clean claim rate on biologic infusion claims
“[Placeholder testimonial] We used to lose entire afternoons chasing down prior auth status for our biologic patients. Now the system tells us exactly what's expiring and when, before it ever becomes a problem.”
[Placeholder Name]
Practice Manager, [Rheumatology Practice Placeholder]
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