Caught $42K of missed prior auths in month one
A behavioral-health group surfaced PA denials buried in inbound faxes — and recovered the revenue before the appeal window closed.
Before
Prior-auth denial letters arrived by fax, mixed in with everything else. Some were caught by the biller within a few days; many sat in the stack until well past the 30-day appeal window. Lost revenue showed up as a write-off two months later with no obvious cause.
After
Every PA-related fax is classified as "prior_auth" and routed to the billing queue with the patient and payer pre-extracted. Denial letters trigger a dedicated subqueue with an SLA timer counting down to the appeal deadline.
How they got there
The "prior_auth" classification was tuned with examples of denial letters from their top three payers. The billing queue has a custom view filtering on "denied" + days-to-deadline. Anything inside seven days of the deadline gets a banner at the top of the dashboard.
"In month one we recovered more PA revenue than the tool cost us for the year. The honest truth is we didn't know how much we were losing."