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Prior authorization software for providers

Rebuilding the infrastructure behind prior authorization.

Your patient data never leaves your environment. The AI sees only structured denial codes and CMS guidelines, never PHI. You keep the final say on every step.

Early access through December 1. No credit card, no contract, no sales call.

HIPAA-aligned architecture Microsoft Azure secured Zero-PHI AI design
Who we serve

One platform for the teams that handle prior authorization.

From facilities to suppliers to the teams billing on their behalf. Wherever prior authorization creates friction, Pre Auth Health handles all of it.

Care delivery

Skilled Nursing Facilities

High-volume, complex PA across multiple payers and care levels, from submission to appeal, in one place.

Independent Clinics

Authorization management for a small team, where one person is often handling all of it.

Behavioral Health

The most sensitive PHI there is, and your clinical data never reaches our AI. Automation without the exposure.

Imaging Centers

Advanced imaging runs through radiology benefit managers with the strictest criteria in Medicare. Match the requirement before you schedule, not after the denial.

Mobile & supplier services

Home Health

Face-to-face, Notice of Admission timing, and OASIS, tracked per episode, with appeals built without adding staff.

DME Suppliers

Written orders, proof of medical necessity, exacting codes, caught before the denial, not after.

Ambulance & NEMT

RSNAT and stretcher medical-necessity documentation, tied to every authorization.

Rural providers & revenue partners

Rural Healthcare

The highest administrative burden with the fewest resources. Self-service, affordable, no IT team required.

RCM Companies

Higher PA and appeal volume for teams working authorizations on behalf of providers. Centralized tracking and appeals in one place.

The problem

Prior authorization is harder to keep up with than it used to be.

Prior authorization has been part of Medicare for a long time. It was always work, but a practice could keep up with it. That has changed. Payers have put AI and automation into the process, and they can pend and deny far more than before, with fewer people actually reviewing what goes out. Requests sit, decisions stall, and the practices on the other end are left keeping up by hand. Private practices and smaller organizations feel it the most.

The average Medicare beneficiary can choose from 39 Medicare Advantage plans, so one practice may be working across dozens at a time, each with its own rules and portal.

53M+
PA requests submitted annually in Medicare Advantage
4M+
Denials issued each year across MA plans
11.5%
Of denials are ever appealed
~80%
Of those appeals are overturned
Source: KFF analysis of CMS Medicare Advantage prior authorization data, 2024.

Most denials are never appealed. The ones that are usually get overturned, which tells you how many were wrong from the start.

Regulatory update · Effective March 31, 2026

Prior authorization just became a compliance issue.

Medicare Advantage, Marketplace, Medicaid, and CHIP managed care plans are now required to publicly report denial rates, appeal overturn rates, and decision timelines every year. For SNFs, clinics, and RCM companies, your PA workflow is no longer only an operational concern. It's a matter of public record. Pre Auth Health is built to help you meet it.

Where we come in

Built to help you keep up.

There are tools that handle prior authorization. Most are built by large companies and priced for hospital systems, not for private practices and smaller teams. Pre Auth Health does the same work those systems do. It's built for the person handling the authorizations, and it's simple to use. Your staff already has a full day, and this isn't one more complicated system to learn.

It won't replace your staff. The AI handles the busywork, but a person on your team makes the final call before anything goes out. That takes the daily weight off the people you already have, eases the burnout, and helps the practice run smoother.

We keep it affordable on purpose. A low price doesn't mean a lesser product. We built this to fix a real problem for the people living with it, and we priced it so they can actually afford to use it.

How it works

From the first request to the final answer.

Every authorization moves through the same clear path, and your team reviews and approves each step along the way.

1
Patient
2
Documentation
3
Policy matching
AI-assisted
4
Submission
via fax
5
Tracking
6
Denial mgmt
7
Appeal generation
AI-assisted
8
Patient notification

Everything in one place

Every authorization, from the first request to the final answer, in one view.

AI-assisted, staff-reviewed

The heavy lifting is automated. Your staff approves every decision.

Fax-based submission

Works with the payer fax workflows you already use.

Handles the volume

Built to keep up whether you're one office or managing many.

Why we built it

I've sat on both sides of this system.

I've worked the payer side of Medicare Advantage, and I've been the patient on the other end of a denial. I've taken over 10,000 Medicare Advantage calls. I know what it sounds like when someone finds out their care was denied and has no idea they were even allowed to fight it.

Then I talked to the offices doing the work: doctors, clinics, RCM teams. Most didn't know they could verify the exact criteria Medicare uses for a CPT code, or that a denial could be appealed at all. The process got so complicated that the people who suffer most are the ones who can least afford it.

So I built the tool I wish they'd had.

I want small practices to stay independent, and patients to get the care they were already owed.

Every practice that stays independent and every patient who gets treated is Pre Auth Health doing its job.

Valerie
Founder & CEO, Pre Auth Health
The payoff

What it changes for your team.

Protects clinician time

Less administrative overhead for the people delivering care.

Reduces avoidable delays

Faster, cleaner submissions mean timelier access to care.

Improves transparency

Real-time visibility into every authorization's status and outcome.

Strengthens appeals

Documentation built to hold up when you challenge a denial.

Pricing

Priced for a practice. No contracts, ever.

Early access: start free for 30 days instead of our standard 14. Pick a plan when you're ready, change or cancel anytime.

Starter
$149/mo
For independent practices and lower-volume workflows getting started with PA management.
Start 30 days free
Most popular
Growth
$399/mo
For mid-size clinics and small SNFs that need AI-assisted appeals and advanced tracking.
Start 30 days free
RCM Flat
$699/mo
For RCM companies and large SNFs with higher PA volume and larger teams.
Start 30 days free
Sign up by December 1 for a 30-day free trial on any plan, in exchange for your feedback. Early access customers keep 10% off their plan price for as long as their subscription stays active. Prefer not to take part? The standard 14-day free trial is always available. No credit card required to start. No contract, no sales call, no waiting on setup.
Running RCM for a lot of clients, multiple locations, or moving into Medicare Advantage? Tell us what you're working with and we'll put together the right plan.
Book a demo
Insights & resources

Notes from someone who reads the rules.

Plain-English takes on Medicare policy, prior authorization, and what's changing for the providers who live with it.

Founder perspective

It's Not What You Do. It's How.

Why I built AI into a healthcare platform, and why I almost didn't. First I had to solve the two things that terrify me about AI in healthcare: patient data exposure and hallucinations.

Compliance update

What the 2026 CMS Transparency Rule Means for RCMs and SNFs

As of March 31, 2026, CMS requires MA plans to publicly report denial rates, overturn rates, and decision timelines. Here's what it signals, and how to prepare.

Pre Auth HealthRead article →
Industry data

Why 80% of Medicare Prior Auth Appeals Are Overturned

Only 11.5% of denials are ever appealed, and most of those get overturned. The pattern points to a systemic problem.

Pre Auth HealthRead article →
Get in touch

Start free, book a demo, or just say hello.

Prefer to talk it through?

Book a 30-minute demo and we'll walk through your own workflows. No forms, no wait. Or reach out about a partnership, the press, or anything else.

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Or email us directly: contact@preauthhealth.com