Dermatology billing services
Dermatology Eligibility and Prior Authorization
In dermatology, the authorization queue is where treatment plans stall. Biologics for psoriasis and atopic dermatitis, phototherapy courses, photodynamic therapy and some surgical procedures all sit behind payer approval, and each plan has its own step-therapy sequence and documentation demands.
What we authorize
- Biologics and targeted therapies, including the step-therapy history and failed-therapy documentation each plan requires.
- Narrowband UVB and PUVA phototherapy courses, including re-authorization before a course runs out.
- Photodynamic therapy for actinic keratosis, where coverage varies sharply by plan and jurisdiction.
- Mohs and excisional surgery where a commercial plan requires approval on lower-risk sites.
- Buy-and-bill drug administration, with the J-code, units and NDC checked against the authorization before administration.
Eligibility and benefit verification before the visit
Every scheduled patient is verified ahead of the appointment: active coverage, plan type, deductible remaining, co-insurance, whether the practice is in network for that specific product, and whether a referral is on file. Cosmetic-adjacent services get an explicit benefit check and, where appropriate, an advance beneficiary notice or a written financial agreement so the patient is not surprised and the balance is collectable.
Tracking, expiry and re-authorization
Authorizations are tracked with their approved units and expiry dates, and renewals are started before the current approval lapses. A lapsed biologic authorization is a denied claim on a drug that has already been administered, which is the most expensive avoidable loss in a dermatology practice.
Frequently asked questions
Do you handle the peer-to-peer when an authorization is denied?
We prepare the clinical packet and schedule the peer-to-peer with the payer; the physician takes the call, which payers require.
How far ahead do you verify eligibility?
Scheduled visits are verified in advance of the appointment date, with same-day additions verified before check-out.
Can you work inside our existing authorization portal accounts?
Yes. We work in your practice management system and the payer portals your practice already uses, under named user accounts with individual access logging.