Questions practices ask

No. The monthly capacity documented in a Payer Desk scope resets each billing period, and unused volume does not roll over.

Additional volume is addressed under the terms documented in the written scope. Organizations with consistently higher volume can move to a broader Payer Desk level or a custom multi-service engagement.

Yes. Each of the eight service lines is available on its own as targeted service-line support, scoped around expected volume, payer mix, workflow complexity, and operating requirements.

Yes. Payer Desk engagements combine Prior Authorization, Eligibility & Benefits, and Claims & A/R follow-up under one managed scope. Other service lines can be added under their own written scope, or the engagement can be structured as a custom multi-service engagement.

No. A Payer Desk engagement covers prior authorization, eligibility and benefits, and claims follow-up at the capacity documented in the written scope. Denials and appeals, credentialing and enrollment, medication access, referral management, and payer contracting are engaged separately or combined within a custom multi-service engagement.

As targeted service-line support, a defined project with a start and finish, or a custom multi-service engagement, depending on what the work is. Each is written into the scope before it begins, with its own pricing, so a managed engagement is never silently stretched to cover work it was not built for.

They are scoped and priced in writing after a review of the work involved, because the volume and complexity vary substantially by practice and payer environment. There is no published price for these services.

No. Formal denial and appeal work is scoped separately because the administrative workload can vary significantly by case.

No. Credentialing & Payer Enrollment is scoped and priced in writing as its own engagement.

No. Fees charged by payers, licensing boards, application programs, or other third parties are separate from Ellery Health Partners engagement pricing and are not included unless the written scope states otherwise.

The Practice Payer Desk provides managed capacity for the payer workflows defined in the engagement. Scope, capacity, responsibilities, and escalation pathways are established in writing. Additional payer workflows may be scoped separately based on volume, complexity, and operational requirements.

No. Authorization, appeal, enrollment, credentialing, contracting, and payment decisions are made by the applicable payer or organization.

Ellery provides managed payer-operations capacity through a defined engagement. Workflows, capacity, responsibilities, reporting, and escalation pathways are established in writing and managed by Ellery within the agreed scope.

Yes. Medication Access & Pharmacy Benefits is a service line in its own right. Ellery Health Partners determines whether a medication processes under the medical or pharmacy benefit, verifies pharmacy benefits, administers pharmacy-benefit and specialty-drug prior authorizations and exceptions, and manages hub, copay, and assistance-program enrollment. Medical-benefit authorizations for procedures, imaging, injections, infusions, therapies, and equipment are handled under Prior Authorization.

No. Clinical decisions, medical-necessity determinations, prescribing decisions, selection or alteration of diagnosis and procedure codes, physician peer-to-peer reviews, provider signatures, and clinical answers to payer questions stay with your practice and your licensed clinicians. Ellery Health Partners does not speak as the treating provider.

Ellery Health Partners manages defined payer-facing administrative workflows across patient access, authorization, reimbursement follow-up, denial resolution, provider enrollment, and network administration. The exact scope of each engagement is established in writing based on the workflows assigned to Ellery.

Independent medical practices and healthcare organizations with recurring payer-operations workload and limited internal capacity to own it. We support outpatient specialties including orthopedics, spine, pain management, dermatology, oncology, infusion, rheumatology, gastroenterology, and neurology, and we are not limited to that list.

No. Ellery Health Partners works inside the systems your practice already uses and authorizes: your EHR or practice-management system, payer portals, PBM and specialty-pharmacy platforms, clearinghouses, and CAQH and PECOS. Your practice provisions the accounts, sets the permissions, and can revoke access. There is no separate Ellery Health Partners patient database.

Payer activity is documented within the practice-approved systems used for the engagement, with each case carrying its current status, the last payer action, the next follow-up, and any deadline. Where supplemental operational tracking is used, it is aggregate and contains no protected health information. Reporting appropriate to the engagement covers case status, deadlines, determinations, unresolved issues, escalations, and recurring administrative barriers. Reporting describes activity and status; turnaround and outcomes are decided by the payer.

As a provisioned user, under accounts your practice creates and can revoke, after a Business Associate Agreement is executed and the security, training, device, and access requirements in your scope are complete. Work is performed inside your systems. Ellery Health Partners does not maintain a separate patient database.

Ellery provides managed payer-operations capacity. Our team works through practice-authorized systems, follows defined workflows and responsibilities, documents payer activity and outcomes, manages routine follow-up, and escalates matters through established pathways when practice or clinical input is required.