Prior-auth packets and denial appeals are pure manual document labor, and the ground is shifting under it: since January 2026, CMS-0057-F forces payers to decide urgent requests in 72 hours and attach a specific reason to every denial, changing the volume and shape of the work your team handles. Our AI assembles the packet, classifies the denial, and drafts the appeal with cited sources; your specialists review and approve. Audit-trailed, human-in-the-loop, built by a senior-led studio.
Assembling prior-auth packets, reading payer rules, classifying denials, drafting appeals, all by hand, against a clock. It's slow, expensive, and hard to scale without hiring. Every hour on paperwork is an hour not spent on the cases that need a human.
Prior-auth packets and appeal drafts are assembled automatically, each claim traced to its source document, so your team handles more volume without more hires, and a human approves every submission with a full audit trail.
Assistive by design: the AI never decides coverage and never auto-submits.
Physician notes, referrals, payer rules, CPT/ICD codes, denial letters, EOB/ERA, pulled from your systems into a secure workflow.
A submission-ready prior-auth packet with missing-info flags, or a denial classification plus an appeal draft, every statement traced back to its source document.
Everything lands in a review queue. A specialist edits and approves; nothing auto-submits. Every action is logged for a complete audit trail.
Turning messy clinical and payer documents into structured, cited output is exactly our muscle. Rated 5.0★ on Clutch.
Relevant build: a medicine-usage analytics platform for a US healthcare company, importing, cleaning, and mapping utilization data at scale.
Before any build, we prototype your prior-auth or denial workflow on synthetic data (no PHI, no risk) and show you the accuracy, the human-review load, and the ROI. You get a plan and a number, whether or not you build with us.
1–2 weeks · credited in full toward your build if you move forward.
Book a call to start →We engineer security-first, sign BAAs, and build to HIPAA and SOC 2 standards, and we've delivered compliant systems for US healthcare and fintech clients. Sales demos use synthetic data only; your PHI never leaves your environment until a signed BAA and security review are in place.
No. It's assistive: it assembles packets, classifies denials, and drafts appeals with cited sources. A specialist reviews and approves every submission. It never decides coverage and never auto-submits.
Alongside it. Platforms cover the common payer paths; we build the parts they don't, a specialty-specific appeal flow, your exception queue, or a payer or clearinghouse integration no vendor will prioritize for one client. You keep your platform and get the workflow it's missing, built to your operation and owned by you.
Your EHR, practice-management, and RCM systems, plus clearinghouses and payer portals. We scope the exact integrations (and their security requirements) in the discovery sprint.
We're a senior-led studio with US offices, we sign BAAs, and we've delivered US healthcare work (a hospital medicine-analytics platform). Synthetic-data demos mean you can evaluate us with zero PHI exposure, and you work directly with the senior-led team building it.
Book a 15-minute call. We'll show a prior-auth or denial workflow running on synthetic data. No PHI, no pitch, no pressure.
Book your call →