13 hrs/wk Prior authorisation is now a clinical role
At $20 to $50 an hour of staff time, before counting the physician hours it consumes. 89% of physicians say it contributes to burnout.
Healthcare
Thirteen hours a week, per physician, spent on prior authorisation.
Ninety-two percent of practices have hired or reassigned staff purely to keep up with it.
Book a 20-minute call Free. No demo, no slides.
39
prior authorisations completed per physician per week, consuming 13 hours.
Source: AMA: survey quantifies time burdens of prior authorization
What is happening
Thirteen hours a week per doctor, spent on paperwork nobody reads twice.
60% Of practices need three or more people to touch one request
A single authorisation crosses the front desk, the clinical team and billing. Nobody owns it end to end, so it stalls.
93% Say it delays patient care
Which is the part that makes this more than an administrative cost.
Care management revenue goes unbilled
APCM pays roughly $54 to $117 per patient per month. Most practices are not billing it, because evidencing the 13 required service elements is an administrative job nobody owns.
Intelligence, plumbed in
An incoming fax becomes a structured authorisation request.
We build the reader and the payer connector, and we report accuracy per payer rather than as one flattering average.
How we make AI survive real data-
Connectors -
A semantic layer -
Evals you can check
What changes
Judge us on this, not on what we built.
Hours returned Authorisation packets assembled automatically
Clinical justification pulled from the chart, payer requirements applied, submitted and tracked. Staff review rather than assemble.
New revenue Care management billed because it was delivered
Eligibility detected across your panel, service elements evidenced month by month, claims generated and defensible under audit.
Fewer denials Requirements checked before submission
Against that payer's actual rules, not a generic checklist.
Research
We wrote a full page on each of these, with the sources.
Each one carries its own figures and the citations behind them. Start with whichever sounds most like your week.
United States
There is a monthly payment you are allowed to bill and are not
A new bundled monthly code. Most practices qualify. Most are billing nothing.
United StatesIn January 2027 prior authorisation gets an API. Almost nobody is ready.
The payers are legally obliged to open up. The providers who built the workflow first will own the transition.
However hard, whatever it is
Prior authorisation is one example. Bring the worst one.
This page is about the paperwork hours. If yours is no-shows, coding or a payer portal that changes every quarter, we work it the same way.
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01 We sit with you
Days where the work happens, not a workshop in a meeting room. We watch the job get done and write down the shortcuts nobody wrote down.
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02 We read everything
Your data, your rules, your vendors and their documentation, and the published research on your sector. We report what is actually in there.
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03 We break it to first principles
Not which tool fixes this. What is actually causing it, taken apart until we reach the piece that cannot be divided further.
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04 Then we build
Weeks, not quarters. By this point we are not guessing what to build, and guessing is the thing that makes projects long.
Where we sit
Your practice system stays. We build the hours back.
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What you get
- Hours returned Authorisation packets assembled automatically
- New revenue Care management billed because it was delivered
- Fewer denials Requirements checked before submission
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Built new for you — none of this exists in your stack today
- An authorisation pack built from the chart, ready to send
- A front-desk screen showing today in one glance
- A patient reminder that actually gets a reply
2
The authorisation layer Reads your practice system. Sends nothing to a payer without sign-off.
Connectors, one agreed meaning per field, and a model reading what no
field holds. Accuracy measured on your own records.
1
- eClinicalWorks
- Athenahealth
- NextGen
- Epic Community Connect
- Availity
What you already run — unchanged, and still yours
If the practice system holds it, we can reach it. A payer portal with no API, an incoming fax, a scanned authorisation letter. All of it can be handled.
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No API -
No documentation -
A terminal from 1994 -
It arrives as paper -
The vendor said no -
It reports nothing
Not a list of limits. Name yours on the call.
And once we can reach it, a model can read it. Most of the value here is in the sources nobody ever structured — the note, the letter, the screen.
Who this is for
The people who feel this first
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Practice Administrator -
Managing Partner -
Director of Operations -
Revenue Cycle Manager -
Medical Director
Straight answers
The questions you would ask on the call
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What is APCM and why does it matter?
Advanced Primary Care Management, launched by CMS in January 2025. It replaces minute-counting with 13 service elements and pays monthly: roughly $16, $54 and $117 per patient per month across G0556, G0557 and G0558. CMS raised the rates about 10% for 2026. With 500 eligible patients at the middle code, that is around $27,000 a month currently unbilled.
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Will this work with eClinicalWorks?
Yes. eCW is one of the systems we know best in live use. That includes the parts the manual leaves out: patchy FHIR support, and behaviour that changes from one install to the next.
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We are a small practice. Is this worth it?
Run the arithmetic before deciding. Count your Medicare patients with two or more chronic conditions and multiply by $54. If that number is small, we will say so rather than sell you a project.
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Can AI handle incoming payer faxes?
It turns them into structured requests. We report accuracy per payer rather than one flattering average, and staff approve everything sent.
Also in healthcare
Healthcare
Skilled nursing & post-acute care
Your team is not wrong about the denials. They just do not have four hours per appeal to prove it.
HealthcareHospitals & health systems
Denials are not a billing problem. They are a documentation problem that surfaces as a billing problem.
HealthcareHome health & hospice
Caregiver turnover is at 79%. The software you bought was designed around the chart, not the caregiver.
Next step
Start with your own numbers.
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We talk
20 minutes. Free.
You tell us what is not working. We ask how the work really gets done.
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We look at your data
A few weeks.
We read your systems, including the notes and letters no field holds. You get what is really in there, what it costs, and the accuracy we can hit.
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We build
A few months.
Only if step 2 says it is worth it. Fixed price, agreed before we start.