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 & Status Update
Every case is tracked from submission to approval. Your office recieves clear status updates without needing to follow up with insurance. We keep full communication with your team throughout the entire process.
All services are included in every plan.
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!
About Us
About Criterion Health Services
Criterion Health Services 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, Concertion 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
Criterion Health Solutions operates as a seamless extension of your practice, managing the insurance authorization process from start to finish.
Your team submits the case.
We manage prior authorizations, appeals, and payer communication.
You receive clear status updates and final determinations without chasing insurance companies.
No additional hiring.
No training burden.
No administrative bottlenecks.
Follow Us On Social