Eliminate care delays and slash insurance denial rates with our fully integrated, intelligent AI clinical engine.
Automated check confirms which procedures and services require authorization for the patient's payer and plan.
Required clinical criteria, medical necessity documentation, and supporting records compiled and structured for submission.
Authorization requests submitted through payer portals or EDI, with structured follow-up until a decision is received.
Auth numbers and approval details captured in the EMR, triggering scheduling confirmation and billing pre-clearance.
Of physicians report PA delays that negatively impact patient care
Average staff hours per week spent on PA at a typical practice
Average cost per manual PA transaction — addressable through automation
Of PA denials eventually overturned on appeal — delays that cost revenue
Automated, pre-scheduling. Payer rules are checked automatically before the visit is booked, flagging exactly which services need authorization so nothing is missed at the point of care.
Specialty-trained specialists. Clinical documentation is compiled by specialists who know each specialty's payer criteria — submitting complete, criteria-matched requests the first time.
Structured appeals workflow. Denied authorizations move into a defined appeals process with the clinical evidence and payer-specific language needed to overturn them efficiently.
Approved authorization numbers and statuses are written directly back into your EMR or PM system — no manual entry, no transcription errors.
Cross-specialty trained. Teams are trained across specialties and payer rule sets, giving multi-location, multi-specialty groups consistent authorization handling at scale.
SCALE manages the full PA lifecycle — from identifying which services need authorization through submission, follow-up, and approval documentation — so authorizations don’t hold up care delivery or delay revenue.
Automated screening flags which scheduled services require prior authorization based on payer rules, plan type, and procedure codes — before work order creation.
Automated screening flags which scheduled services require prior authorization based on payer rules, plan type, and procedure codes — before work order creation.
Authorization requests submitted via portal, fax, or EDI and actively tracked. Structured follow-up ensures no PA falls through the cracks or ages without resolution.
PA denials routed to specialist review for peer-to-peer scheduling, appeal letter preparation, and resubmission — maximizing approval rates without physician administrative burden.
Prior authorization is one of the highest-burden administrative processes in healthcare — and the downstream cost extends well beyond staff time into delayed procedures, abandoned care, and revenue leakage.
AMA survey data shows the vast majority of physicians experience PA-related care delays — a clinical and operational problem that efficient PA management directly addresses.
The average physician practice dedicates nearly two full working days per week to prior authorization tasks — time that scales with volume and consumes clinical and administrative resources.
Each manually processed authorization carries material per-transaction cost. At multisite scale, this compounds rapidly — and is highly addressable through automation and outsourcing.
The majority of initial PA denials are eventually reversed — indicating the problem is often documentation or process, not clinical appropriateness. Structured appeals deliver material revenue recovery.
Studies show a significant share of patients never complete their approved procedures after authorization delays — representing lost revenue and degraded outcomes.
SCALE brings deep experience across the MSO and physician enterprise market — including the specialty-specific PA complexity that multi-site organizations encounter at volume.
Rules-based engine evaluates scheduled services against payer-specific PA requirements — flagging authorizations needed before any manual work begins.
PA specialists retrieve relevant clinical records, apply payer-specific criteria, and assemble complete submission packages — reducing initial denial rates at the source.
Every authorization is submitted and tracked against payer SLAs. Structured escalation workflows ensure no case ages without action or resolution.
Auth numbers, validity dates, and approval details are documented directly in the EMR — triggering billing pre-clearance and scheduling confirmation automatically.
Denied authorizations are routed for specialist review, appeal preparation, and peer-to-peer coordination — with physicians engaged only when clinically necessary.
Cardiology Stress Test · UHC
Submitted 48h ago · awaiting decision
Orthopedic MRI · Aetna
Documentation pending · 24h to deadline
Spine Surgery · BCBS
Auth #: BCB-2940123 · Valid 90 days
Infusion Therapy · Cigna
Appeal submitted · 3-day SLA
Colonoscopy · Humana
Auth #: HUM-7831002 · Valid 60 days
Avg submission time
Cases tracked to resolution
Auth capture, native
Prior authorization is one of the highest-burden administrative processes in healthcare — and the downstream cost extends well beyond staff time into delayed procedures, abandoned care, and revenue leakage.
AMA survey data shows the vast majority of physicians experience PA-related care delays — a clinical and operational problem that efficient PA management directly addresses.
Auth numbers and approval details captured directly into your PM or EMR system — no manual re-entry, no transcription errors, no workflow gaps.
PA criteria and clinical documentation standards vary significantly by specialty. SCALE's teams are trained to the specific requirements of musculoskeletal, cardiovascular, oncology, and other high-PA specialties.
Initial denials don't stop at rejection. SCALE's appeals workflow covers peer-to-peer coordination, letter preparation, and resubmission — recovering revenue that most organizations abandon.
ISO 27001 certified, HIPAA compliant, and SOC2-aligned. Clinical documentation and payer communication handled with the same security rigor as SCALE's RCM operations.
Multi-location, multi-specialty PA environments require infrastructure, not just effort. SCALE's workflows are designed to scale across hundreds of authorizations per day without quality degradation.
