Access & Approvals
Reduce referral leakage, authorization delay, avoidable cancellations, and patient uncertainty.
GoHealthcare Practice Solutions
Specialty healthcare operations for pain, spine, orthopedic, neuromodulation, PM&R, and ambulatory surgery organizations
What We Do
One operating partner across patient access, prior authorization, clinical operations, revenue integrity, compliance, payer strategy, technology, and performance.
GoHealthcare helps specialty organizations reduce administrative friction, prepare care more reliably, protect reimbursement, strengthen controls, and build infrastructure that scales.
25+Years in healthcare operations and management
500+Physicians and practice groups served
3.5M+Authorization requests reviewed, submitted, and processed
98%Reported prior authorization approval rate
50U.S. states supported
01
Business Impact
What We Help Healthcare Organizations Improve
The visible problem may be an authorization backlog, a canceled procedure, a denial trend, an aged receivable, or staff overload. Our work identifies and corrects the connected operational causes.
Revenue Performance
Strengthen clean claims, payment accuracy, denial prevention, collections, and revenue recovery.
Operational Control
Create visible workflows, ownership, service levels, staffing discipline, and reliable handoffs.
Compliance & Scale
Embed controls, audit readiness, technology governance, and infrastructure for sustainable growth.
02
Integrated Specialty Operations
One Operating Model Across the Patient and Revenue Journey
Patient access, medical necessity, authorization, procedural readiness, coding, reimbursement, compliance, technology, and performance are not separate systems. Each stage affects the next.
Demand & Referral
Referral intake, scheduling, registration, eligibility, benefits, and patient communication.
Coverage & Approval
Medical necessity, payer requirements, prior authorization, escalation, and decision management.
Care Readiness
Documentation, records, imaging, clinical validation, procedure scheduling, and facility coordination.
Revenue Integrity
Coding, charge capture, claims quality, payment accuracy, compliance, and audit controls.
Recovery & Resolution
Denials, appeals, aged receivables, underpayments, contract variance, and unresolved balances.
Intelligence & Scale
Technology, AI governance, dashboards, workforce accountability, and continuous improvement.
The GoHealthcare Operational Excellence Framework™
Our eight excellence frameworks connect patient access, clinical and utilization management, practice operations, compliance, revenue integrity, technology and AI, performance intelligence, and leadership governance into one specialty operating system.
Explore the 8 Excellence Frameworks™
03
Service Capabilities
Specialty Support From Access Through Enterprise Performance
Services may be delivered as a fully managed function, focused transformation initiative, implementation program, audit and remediation engagement, or ongoing advisory partnership.
01
Prior Authorization & Utilization Management
Manage complex requests from intake through payer decision with specialty-specific medical-necessity review, documentation readiness, submission, follow-up, escalation, and denial prevention.
- Payer-policy and clinical-criteria review
- Authorization intake, submission, and tracking
- Reconsiderations, appeals, and peer-to-peer preparation
- In-network, out-of-network, workers’ compensation, and motor vehicle cases
02
Patient Access & Scheduling
Create a reliable pathway from referral receipt to a clinically and financially prepared appointment or procedure.
- Referral intake and conversion
- Registration, eligibility, and benefits verification
- Financial clearance and patient communication
- Scheduling, wait-list recovery, and access coordination
03
Clinical & Surgical Operations
Coordinate documentation, records, imaging, medical necessity, facilities, schedules, and procedural readiness across complex MSK care pathways.
- Clinical documentation readiness
- Surgical and procedural coordination
- Records, imaging, implants, and facility readiness
- Clinical workflow design and escalation management
04
Revenue Cycle Management & Revenue Integrity
Connect front-end accuracy and clinical documentation to coding, clean claims, payment, denial prevention, accounts receivable, and recovery.
- Billing, coding, charge capture, and claims
- Payment posting and payer follow-up
- Denial prevention, appeals, and root-cause correction
- A/R, underpayment, contract variance, and revenue recovery
05
Coding, Compliance & Audit Readiness
Strengthen documentation, coding, billing, authorization, privacy, security, and operational controls before a payer, regulator, or auditor identifies the risk.
- Coding and documentation audit review
- Medical-necessity and payer-policy alignment
- HIPAA, CMS, Medicare, and billing controls
- Corrective action, education, monitoring, and audit readiness
06
Payer Credentialing, Contracting & Reimbursement
Improve speed to participation and protect reimbursement through disciplined enrollment, contracting, network, fee-schedule, and payer-performance management.
- Provider credentialing and payer enrollment
- Contracting and network participation
- Reimbursement and fee-schedule analysis
- Contract administration and payer escalation
07
Practice Operations, Growth & Transformation
Build scalable operating infrastructure with clear workflows, ownership, standard procedures, workforce expectations, implementation governance, and performance routines.
- Workflow redesign and SOP governance
- Staffing, productivity, capacity, and accountability
- New locations, service lines, and operational integration
- Practice turnaround, project management, and change adoption
08
Technology, Data & Responsible AI
Align technology with real workflows through EHR optimization, interoperability, automation, secure data use, AI readiness, governance, deployment, and monitoring.
- Technology and workflow readiness assessment
- EHR optimization, integration, and automation
- AI governance, implementation, and human oversight
- Data quality, cybersecurity, analytics, and monitoring
09
Performance Intelligence & Executive Governance
Turn operational and financial data into trusted measures, visible ownership, faster decisions, corrective action, and sustained improvement.
- Executive dashboards and KPI governance
- Access, authorization, denial, payer, and A/R analytics
- Benchmarking, forecasting, and capacity insight
- Leadership review, accountability, and benefit validation
10
CCM, RTM & RPM Program Implementation
Design compliant, coordinated chronic care and remote-monitoring programs that integrate enrollment, consent, devices, care plans, documented time, billing, quality assurance, and reporting.
- Program design and patient identification
- Enrollment, consent, care plans, and engagement
- Technology, device, and workflow integration
- Documentation, billing readiness, compliance, and KPIs
04
Specialty Focus
Built Around Complex MSK and Specialty-Care Workflows
GoHealthcare is designed for organizations whose care pathways depend on detailed documentation, payer-specific medical-necessity criteria, complex procedures, coordinated facilities, specialized coding, and disciplined reimbursement management.
Interventional Pain Management
Orthopedic Surgery
Spine & Neurosurgery
Neuromodulation
Physical Medicine & Rehabilitation
Ambulatory Surgery Centers
Musculoskeletal Care
Multi-Location Practices
Healthcare Platforms & Investors
Workers’ Compensation & MVA
05
Experience and Performance
Specialty Knowledge Supported by Measurable Operational Experience
GoHealthcare combines clinical knowledge, payer intelligence, revenue discipline, operational management, compliance controls, and technology governance across the complete specialty-care journey.
25+years in healthcare operations and management
500+physicians and practice groups served
3.5M+authorization requests reviewed, submitted, and processed
98%reported prior authorization approval rate
50U.S. states supported
06
Client Experience
What Healthcare Leaders Say About Working With GoHealthcare
Selected brief excerpts from published client testimonials. Visit the full reviews page for complete statements and additional feedback from physicians, executives, administrators, nurses, and business partners.
“
“Dependable and professional partner.”
Jesus Lao, M.D.
Spectrum Spine Care, San Diego, California
Client perspective: Long-term operational support, clear communication, collaboration, and reliable follow-through.
Reported Operational Impact
Improved authorization accuracy, efficiency, and timeliness
Melissa Falkowski, RN, BSN
Chief Operating Officer, International Spine, Pain & Performance Center and Mountain Spine and Pain
Client perspective: Rapid onboarding, responsive leadership, and a successful transition to outsourced prior authorization support.
Reported Practice Results
Backlog recovery and stronger procedure scheduling
Penny Forbes
Practice Administrator, Nevada Pain and Spine Specialists
Client perspective: The published review reports successful backlog work, no claim denials for missing authorization, and increased procedure scheduling volume.
07
Ways to Engage
Support Designed Around the Problem You Need to Solve
Fully Managed Services
Ongoing operational ownership of defined functions, work queues, service levels, reporting, and quality controls.
Targeted Transformation
Focused remediation of backlogs, denials, access constraints, coding risk, payer issues, or underperforming workflows.
Advisory & Governance
Executive assessment, operating-model design, policy, compliance, technology, AI, payer, and performance guidance.
08
Explore GoHealthcare
Services, Case Studies, Frameworks, and Client Experience
Prior Authorization Resource Center
Explore payer criteria, medical necessity, workflow guidance, specialties, and procedure resources.
Explore Prior Authorization →Revenue Cycle Knowledge Center
Review the full revenue journey from access and documentation through reimbursement and recovery.
Explore Revenue Cycle Management →22 Case Studies
Review real-world engagements across access, authorization, RCM, compliance, payer strategy, technology, and growth.
Explore Case Studies →8 Excellence Frameworks™
See how the eight operating frameworks work together as one accountable specialty system.
Explore the Frameworks →Client Testimonials
Read complete feedback from physicians, executives, administrators, nurses, and healthcare business partners.
Read Client Reviews →Leadership
Meet the clinical, operational, financial, compliance, technology, and executive leaders behind GoHealthcare.
Meet Our Leadership →Strengthen Your Specialty Operating Model
Build Greater Control Across Access, Approvals, Operations, Compliance, and Revenue
Discuss prior authorization, revenue cycle management, patient access, clinical operations, coding, compliance, payer strategy, technology, AI governance, performance intelligence, or an enterprise transformation initiative.
Service Provider
GoHealthcare Practice Solutions
Healthcare operations, patient access, prior authorization, clinical utilization, revenue integrity, compliance, payer strategy, technology, AI, and performance support for complex specialty organizations.
Service and Performance Disclaimer
This page provides a general description of GoHealthcare Practice Solutions’ business-to-business operational and advisory capabilities. It is not medical, legal, regulatory, coding, billing, reimbursement, cybersecurity, accounting, investment, or payer-contract advice. Service scope, implementation approach, timelines, and results vary by organization, specialty, payer mix, technology, staffing, documentation quality, contractual arrangement, and other operating conditions. No specific authorization, financial, compliance, reimbursement, clinical, or performance result is guaranteed.
GoHealthcare Practice Solutions ·
Contact the team
· Call 1 (800) 267-8752