Dermatology billing services
Dermatology Prior Authorization Services
Prior authorization in dermatology is the payer approval obtained before a specific drug, therapy or procedure is provided. It is a separate step from eligibility verification: eligibility asks whether coverage exists, prior authorization asks whether this particular treatment is approved under that coverage. It applies most often to biologics, phototherapy courses, photodynamic therapy and selected surgical cases.
This service is one part of our dermatology medical billing services, and it can be run on its own or alongside the rest of the revenue cycle.
What requires authorization in dermatology
- Biologics and targeted therapies, including the step-therapy history and failed-therapy documentation each plan requires.
- Narrowband UVB and PUVA phototherapy courses, authorized as a defined number of sessions within a date window.
- 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 approval before administration.
How the authorization runs in practice
Each request is built as a clinical packet rather than a form: diagnosis and severity, prior therapies with dates and outcomes, contraindications, and the exact code and unit count to be billed. Submission goes through the payer portal where one exists, and each case carries an owner, a submission date and a follow-up cadence rather than waiting on a callback.
When a request is denied, we assemble the peer-to-peer packet and schedule the call; the physician takes the call, which payers require. Denied-then-approved cases are logged by payer and reason so the next submission for that plan opens with the evidence that plan actually reads.
Units, expiry and re-authorization
Approvals carry approved units and expiry dates, and both are tracked against what has actually been administered. Renewals start before the current approval lapses, because a lapsed biologic authorization becomes a denied claim on a drug already given, 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.
Is eligibility verification included in this service?
Eligibility and benefits verification is a separate service, because it answers a different question and runs on every scheduled patient rather than only on authorized treatments.
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.
Related dermatology billing services
- Dermatology Medical Coding Services
- Mohs Surgery Billing and Coding
- Dermatopathology Billing Services
- Dermatology Denial Management and Appeals
- Dermatology A/R Recovery Services
- Dermatology Credentialing and Payer Enrollment
- Dermatology Eligibility and Benefits Verification
- Dermatology Patient Billing and Statements
- Dermatology Practice Analytics and Benchmarking
Talk through your own numbers
A claims review shows what this service would change for your practice before any agreement is signed.
Request a free claims audit