Frequently Asked Questions

  • What is a prior authorization (PA) request?

    A PA request is an extra step that is sometimes required before a member receives a specific service or procedure. A PA will not allow a service that is non-covered or a specific exclusion under the Member Certificate. For example, if cosmetic surgery is an exclusion of the policy, a PA will not change that benefit.

  • When and why is a PA needed?

    PA is a technique for minimizing costs, wherein benefits are only paid if the medical care has been pre-approved by the insurance company. Some specific services require PA so that Medical Affairs can review the medical necessity of these services. Seeking services with non-plan providers/out-of-network will usually require PA.

  • How is a PA obtained?

    A member must obtain a written authorization letter from the concerned Payer, approving the requested service or procedure, to give to the Provider. It is the member’s responsibility to secure written authorization approval before receiving treatment to ensure proper handling of the claim.

  • What is PriorAuthOnline?

    PriorAuthOnline allows healthcare professionals to have all their prior authorizations taken care of by trained experts, by sending their requirements, having them processed and getting back the requisite approval, all via online means. PriorAuthOnline works on PA requests for all Medicare Part D plans, Medicaid plans, and virtually all Commercial plans.

  • Why should I use PriorAuthOnline?

    PriorAuthOnline is designed to take the pain out of prior authorization. You can save an enormous amount of time and money by partnering with us. Eliminate errors, minimize effort and free yourself from tedious paperwork, and get more auths completed in less time.

  • How does PriorAuthOnline keep my information safe?

    We work hard to take every step necessary to protect health-related data. All information transferred to and from PriorAuthOnline is encrypted through SSL (Secure Sockets Layer) technology, up to and above the industry standard. Our servers are managed securely and backed up properly, among other safeguards. Our Terms of Service comply with insurance plan rules, as well as Medicare, Medicaid, and HIPAA guidelines.

    Your demographic and patient information is protected by our Privacy Policy and only used to help you complete PA requests for your patients. Individually identifying patient data is not shared with any other party, including our clients.

  • How do I help a patient with no drug coverage?

    PriorAuthOnline provides prior authorization assistance for patients with prescription drug coverage. If you have a patient who does not have insurance for medications, you may want to contact The Partnership for Prescription Drug Assistance via the web at or by phone at 1-888-4PPA-NOW (1-888-477-2669) or another payment assistance program.

  • What browsers do you support?

    PriorAuthOnline is fully compliant with the following browsers:

    • Google Chrome
    • FireFox 3.5 or later
    • Internet Explorer 7.0 or later
    • Safari 3.0 or later
  • Do I need to install software to use PriorAuthOnline?

    No. PriorAuthOnline is web based, and does not require any additional software on your computer.

  • How do I log into my account?

    To log into your PriorAuthOnline account, scroll to the top of this page and click on the button that says "SIGN IN". Enter your username and password, then click the button labeled "LOG IN".

  • How do I know if the plan approved the PA request?

    The plan will alert the provider's office by fax when a PA request is approved. The plan will typically notify them using the fax number on the submitted PA. For electronic PA requests, you may also receive a determination directly through PriorAuthOnline. On average, it takes between 1 and 5 business days for the plan to come to a determination.

    It is typically up to the provider to let the pharmacy know when they can fill the prescription. Pharmacies can request to be notified of PA determinations by updating their preferences in PriorAuthOnline. While this is not a guarantee that the plan will notify the pharmacy, it does add the pharmacy's contact information and notification request to the PA.

What Customers Say

  • How busy your days can get! Overall, I think the quality we most value is communication. It is very important to maintain good communication levels and Sun Knowledge has been great at doing so. The staff that we are actively in contact with go above and beyond by paying close attention to detail and effectively communicating their findings with us. The staff is kind and respectful and we have created a lovely partnership that we continue to look forward to.

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    I wanted to share how pleased Tom and I are with the relationship we have with the Sun Knowledge team. P***** and team are doing a great job. We finally feel that we have great visibility into what is driving our revenue cycle and that we have a capable team that lives up to our high expectations. I know that my communication style / feedback can be right to the point, but I just wanted to make clear that we are very pleased with what Sun Knowledge and P***** brings to our organization.

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  • "Again we appreciate the efforts of your team and are quite impressed with the progress to this point. The below refinements are expected as part of any new partnership, particularly in our highly complex system. ... Thank you again for your efforts – your team continues to meet our expectations and is actively improving our ability to serve our patients. Your efforts specifically to maintain open communications with our team has fostered the success of this effort and we look forward to expanding the effort next week and beyond."

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