Payers have deadlines too. We keep them.
Since January 2026, Medicare Advantage and Medicaid plans must decide medical prior authorizations within 7 days, 72 hours if urgent.26 We track every clock and appeal every denial worth appealing.
Early access in Texas and Oklahoma
- Every prior auth clock, by plan type and state
- Late decisions caught, with what the rule says happens next
- Cited appeal packets your clinicians sign
- Payer scorecards from the numbers payers must publish
The problem
Prior auth fills the week
Practices complete about 40 prior authorizations per physician each week.28
Appealed denials often reverse
The largest Medicare Advantage insurers reported overturning 67% of appealed standard denials in 2025.29
Late has consequences
In Medicare Advantage, a late decision is itself an appealable denial.27 In Oklahoma, a missed deadline can mean the request is approved.30
What you get
- One queue of open prior auth clocks, late decisions and appeals due.
- The rule for each case: Medicare Advantage, Medicaid, ERISA, marketplace, Texas or Oklahoma.
- Appeal and reconsideration packets drafted from the denial reason and your records, for your clinician to sign.
- Texas gold-card status and Medicare prior auth programs in Texas and Oklahoma, tracked.
- Recovered dollars matched to the payments that arrive.
How it works
- 01
Send what you already get.
Denial letters, portal exports and 835 files. No EHR change needed.
- 02
We start the clocks.
Every case gets the deadline its rule sets.
- 03
Your clinician signs.
Packets cite the payer’s policy and your chart.
- 04
We track the result.
Overturned denials matched to payment.
Who it is for
- Spine, orthopedic, pain and neurosurgery groups in Texas and Oklahoma
- The billing companies that serve them
- ER groups using Revise IDR, for logging post-stabilization requests
What we never do
- Contact your patients
- State medical necessity without your clinician’s records
- Promise approvals
Pricing
Pricing at early access.
Do you submit prior authorizations?
Not in the first version. We work after the payer decides: deadlines, late decisions and appeals. Submission comes later, through partners.
What happens when a payer decides late?
It depends on the rule. In Medicare Advantage, a late decision is itself an appealable denial. In Oklahoma, a missed deadline can mean the request is approved. Each late case shows the next step its rule allows.
Who signs the appeals?
Your clinician. We draft each packet from the denial reason, the payer’s policy and your records, and never state medical necessity on our own.
Which plans?
Medicare Advantage, Medicaid managed care, ERISA plans, marketplace plans, and state-regulated plans in Texas and Oklahoma.
Do we need to change our EHR?
No. We start from the denial letters, portal exports and remits you already receive.
When can we start, and what does it cost?
Auth is in early access for practices in Texas and Oklahoma. Pricing is set at early access.
Sources
- 26CMS Interoperability and Prior Authorization final rule (CMS-0057-F) fact sheet: decision timeframes and specific denial reasons from January 1, 2026; prior authorization APIs from January 1, 2027. Source
- 2742 CFR 422.568: Medicare Advantage organization determinations, timeframes, and a late notice treated as an adverse determination that may be appealed. Source
- 28American Medical Association, 2025 AMA prior authorization physician survey (web survey of 1,000 practicing physicians, December 2025): on average, practices complete 40 prior authorizations per physician per week. Source
- 29KFF, August 13, 2026, analysis of 2025 prior authorization metrics posted by the largest insurers (14 across three markets; six in Medicare Advantage): 67% of appealed standard Medicare Advantage denials overturned, weighted by enrollment. Source
- 30Oklahoma HB 3190 (36 O.S. 6570.1 to 6570.11), effective January 1, 2025: decisions within 72 hours (urgent) or 7 days (non-urgent) of receiving all necessary information; services deemed authorized when the utilization review entity misses a deadline and the provider submitted all necessary information through the entity's authorized prior authorization system. Source
- 3145 CFR 149.110(b)(1): emergency services covered without any prior authorization determination, even out of network. Source
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