Prior Authorization Automation
Prior auth is the most expensive clerical work in healthcare. We build the pipeline that pulls clinical evidence from the EHR, maps it to each payer's criteria, assembles the packet, submits through portal or fax, and chases status until approval or denial with an appeal path ready.
Scope of the build
Fixed scope, fixed timeline, 100% U.S.-based senior engineers on Eastern-time hours.
- Payer criteria library with versioning
- Clinical evidence extraction from EHR notes
- Packet assembly with citation back to the chart
- Portal, fax, and 278 submission paths
- Status polling and denial-reason capture
- Appeal workflow with template letters
What you get
Days off the cycle
Submission the same day the order is written.
Fewer denials
Criteria checked before submission, not after.
Auditable
Every packet ties to source notes and a decision trail.
Where this fits
- → Specialty practices
- → Imaging centers
- → Infusion and specialty pharmacy
- → Provider RCM teams
From signature to production
The same delivery rhythm on every engagement. You always know what shipped last week and what ships next.
- Week 0
Scope lock
Two working sessions with your team. We write the spec, the acceptance criteria, and the integration list, then fix the price against it.
- Weeks 1-2
Spine first
Data model, auth, environments, CI, and the riskiest integration go in before any screen is polished. You see it running in staging.
- Mid-build
Weekly demo
Working software every Friday, on your staging environment. Scope changes get priced in the same call, never discovered at the end.
- Go-live
Handover that holds
Runbooks, monitoring, test suite, and a recorded walkthrough for your engineers. You own the repo and the accounts from day one.
Before you book a call
Straight answers on price, timeline, ownership, and who writes the code. If your question is not here, ask it on the call — we answer it the same way.
Scope prior authorization automation →What does prior authorization automation cost?
From $65,000. The price is fixed against a written scope after a two-session discovery, so the number you approve is the number you pay. Typical delivery runs 8–12 weeks.
How long does it take to go live?
8–12 weeks from scope lock to production for the scope listed on this page. You see working software in your staging environment every week, starting in week two.
What does it integrate with?
Out of the box we wire Epic FHIR, Availity, Change Healthcare, Twilio Fax and Postgres. Anything with an API or a file drop can be added during scope lock.
Who actually builds it?
Senior U.S.-based engineers on Eastern-time hours. No offshore handoff, no rotating junior bench. The people on your kickoff call are the people writing the code.
Do we own the code?
Yes. Your repo, your cloud accounts, your data — from the first commit. We hand over runbooks, tests, monitoring, and a recorded walkthrough so your team can take it forward without us.
Can this start smaller than the full scope?
Usually. We can carve a first slice that proves the hardest part of prior authorization automation in a few weeks, then sequence the rest once it is running in production.
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