Prior Auth That Doesn't
Hold Up Your Cycles
In fertility medicine, a delayed authorization means a delayed cycle. Our prior auth management is aggressive, organized, and built around your scheduling workflow.
Book a Free Audit →Our Prior Auth Process
Benefit Verification
Before submission, we verify fertility coverage, lifetime max, and prior-auth requirements for each payer.
Auth Submission
We submit via each payer's preferred channel — portal, fax, or phone — with all required clinical documentation.
Status Tracking
Active follow-up on every open authorization so no request ages past its review window without action.
Appeals & Peer-to-Peer
When initial auth is denied, we prepare the appeal or coordinate peer-to-peer review with your medical director.
Cycle Scheduling Coordination
We flag approved authorizations back to your clinical scheduler so cycles proceed without billing hold-ups.
Common Questions About Fertility Prior Authorization
How long does fertility prior authorization typically take?
Most commercial payers process fertility prior auth requests within 3–7 business days. Fertility benefit managers like Progyny often have faster turnaround (1–3 days) due to streamlined electronic submission. Rush or peer-to-peer requests can be processed in 24–48 hours at many payers.
Does IVF prior auth cover the whole cycle, or just the procedure?
It depends on the payer. Many require separate authorizations for monitoring visits, the egg retrieval, the lab procedures (89xxx series), and the embryo transfer. Authorization for "IVF" alone is often insufficient — each component may need to be listed explicitly on the authorization request.
What happens if a prior authorization expires mid-cycle?
Claims billed after the authorization expiration date will typically deny, even if the procedure was already approved. We track expiration dates for all active authorizations and proactively request extensions when a cycle window extends toward an expiration date.
Can a prior authorization denial be appealed?
Yes. Most clinical prior auth denials can be appealed through a formal reconsideration request or a peer-to-peer review between your physician and the payer's medical director. We prepare the appeal documentation and coordinate the peer-to-peer when needed. Appeal success rates for fertility prior auth are significantly higher than general medical — especially with supporting clinical documentation.
Are auth delays affecting your cycle volume?
Our free audit reviews your current prior auth workflow and identifies where delays are occurring — and how to fix them.
Book Your Free Audit →