Pharmacist-Led Prior Authorization Support for Medical Practices
Criterion Health Solutions handles insurance approvals, denials, and appeals so your staff can focus on patient care instead of paperwork
Our Services
Prior Authorization Management
We handle the full prior authorization process with insurance providers so your staff never spends time navigating portals, faxing forms, or sitting on hold.
Insurance Appeals & Denial Solutions
When medications or therapies are denied, we prepare and submit professional appeals with clinical justification to secure approvals quickly. Additionally, we offer peer to peer (P2P) preparation and support to ensure the highest likelihood of success.
Benefits Investigation & Verification
We verify patient coverage, medication eligibility, and insurance requirements before submission to prevent delays and rejections.
Medical Records & Document Coordination
We gather, organize, and submit all required chart notes and documentation insurance companies request for approvals and appeals.
Case Tracking and Status Update
Every case is tracked from submission to approval. Your office receives clear status updates without needing to follow up with insurance. We keep full communication with your team throughout the entire process.
Your Dedicated Authorization Department
Criterion operates inside your existing EMR as an extension of your practice. We handle all authorizations and appeals so your staff can focus on patient care.
If your staff can access it, we can work inside of it!
All services are included in every plan.
About Us
About Criterion Health Solutions
Criterion Health Solutions was created to solve one of the most frustrating realities in healthcare — insurance approvals delaying patients from receiving the medications their doctors prescribe.
Founded by a Doctor of Pharmacy and an operations professional, Criterion was built from firsthand experience with the clinical frustration and administrative burden prior authorizations place on medical practices.
Our mission is simple…
To remove the insurance workload from your staff so you can focus on patient care while we handle the approvals, denials, and appeals.
We operate as a seamless extension of your office. Quietly, reliably, and professionally.
Your team submits the case. We handle the rest. specialize in providing healthcare facilities with turnkey operational support, allowing medical professionals to focus on delivering exceptional patient care. Our multidisciplinary team blends clinical insight with operational excellence to create safer, more efficient, and compliant environments.
How Criterion Works
We integrate into your workflow and manage prior authorizations from start to finish without adding burden to your staff.
1. Workflow Integration
We align with your existing processes and EMR system to ensure a seamless handoff. There is no disruption and no retraining required. We function as a natural extension of your current workflow.
2. End-to-End Prior Authorization Management
We handle the full lifecycle of each request, including submission, documentation, payer communication, and follow-up. Each case is tracked closely so nothing falls through the cracks.
3. Ongoing Coordination
We communicate directly with your team, pharmacies, and insurance providers. This allows issues to be resolved quickly and helps prevent delays in patient care.
4. Reduced Administrative Load
Your staff can remain focused on clinical responsibilities while we manage prior authorizations in a structured and reliable manner.
Let’s Work Together
Contact our experts today to schedule a no-obligation consultation and discover how we can elevate your facility’s performance.
