Prior authorization
The pre-auth was missing. The claim denied. The patient is upset.
Prior authorization denials cause ~15–20% of avoidable claim rejections, waste 30–60 staff minutes per PA, and erode patient trust. We catch PAs at the source — so the claim goes clean the first time and the patient doesn't hear "your insurance didn't approve that" at check-in.
Prior auth is a tax on modern medicine. The procedure's been scheduled. The patient's arranged childcare. The surgeon's blocked the OR. And then on the morning of the procedure, somebody discovers the PA was never obtained — or was obtained for the wrong code — and everything grinds.
The alternative — a dedicated PA workflow — isn't new. But it's rare enough outside of large health systems that independent practices assume it's not feasible. It is. We run it for them.
The economics are clear: every denied claim due to missing PA is 30–60 minutes of staff rework, plus 30–90 days of cash flow delay, plus whatever damage the patient-facing conversation did to loyalty.
Concretely, this is the work.
PA management for high-PA specialties — plastic surgery (reconstructive), cardiology (procedures), DME, advanced imaging, specialty pharmacy.
Eligibility and benefit verification before scheduling, not after.
PA initiation at the point of decision, not at the point of service.
Payer-specific rule tracking — each payer's PA rules are different, and they change quarterly.
Appeal management when PAs are initially denied with appealable grounds.
Patient-facing communication so nobody's surprised at check-in.
PA metrics in the monthly financial packet — denial rate, average approval time, top PA-requiring codes.
PA is an operations problem, not a clerical one
We treat PAs as a workflow — staffed, tracked, and measured. Most practices treat them as whatever spare capacity is left at the front desk.
Payer-rule currency
Payer PA rules change. We track them so your staff doesn't have to.
Integrated with billing
The PA and the claim share a source of truth. Denials due to PA mismatch disappear.
No cliff. No rip-and-replace.
Weeks 1–2 · Diagnose
Audit the last six months of PA-related denials. Identify the top PA-requiring codes in your practice. Map the current workflow.
Weeks 3–6 · Install
PA workflow rebuilt. Payer-rule library installed. Staff trained on handoffs. First clean month runs.
Ongoing
Monthly PA metrics. Quarterly payer-rule refresh. Appeals escalated as needed.
Real numbers, measured against your own baseline.
- Target denial rate due to PA issues
- <5%
- PA initiation timing
- Pre-service
- Target appeal turnaround
- 48 hrs
- PA performance reporting
- Monthly
Plastic surgery (reconstructive), cardiology interventional groups, DME-heavy practices (podiatry especially), dermatology with Mohs/advanced therapies, and any practice where missing a PA creates a bad patient conversation.
Free audit
Curious where your practice is leaking money?
We'll audit your current workflow for free and show you exactly where to act — usually in under a week. No contract. You keep whatever we find.