Prior Auth Tracking Engine
A live queue of every authorization by payer, patient, aging bucket, and missing documentation. Auto-escalations, expiration alerts, and one-click packet regeneration.
What this engagement solves
If your prior auth queue lives in a spreadsheet one person owns, you have a single point of failure costing you money every week. Aging auths and missing docs don't surface until somebody opens the right tab.
One person owns it. When they take PTO, the queue stalls. Leadership can't see status without asking.
Which auths are 30 days old? 60? 90? Which are about to expire next week? Spreadsheet sort-and-filter is not a tracking system.
The payer rejects the packet because a swallow study or sleep study wasn't attached. The clock restarts. The patient waits.
When you re-submit, you re-attach everything by hand. Half the time the new packet has a different set of documents than the original.
Beat the prior-auth clock
CMS keeps adding DME items to the required prior-auth list — watch how automated pre-submission checks turn denial risk into an 84%+ approval rate.
What you get
Fixed scope. Fixed price range. Delivered on the platform you already run.
Deliverables
- Live queue dashboard — every auth by payer, patient, aging bucket, expiration date
- Payer-specific documentation checklists baked in (Medicare, Medicaid MCOs, top commercial payers)
- Auto-escalation rules — auths idle > X days route to a named owner
- Expiration alerts at 30 / 14 / 7 days before expiry
- One-click packet regeneration with documents auto-pulled from Brightree / WellSky
- Aging bucket report — leadership sees the queue without asking
- HIPAA-compliant audit trail of every status change
Platforms we sit on top of
Brightree · WellSky TeamDME · NikoHealth · Bonafide. We add a layer; we don't replace your system of record.
Outcomes
Rounded ranges from real DME engagements. No marketing inflation.
Frequently asked questions
Does this replace Brightree's auth tracking?
No — it augments it. Brightree tracks the auth record. This engine adds the aging, expiration, and missing-doc workflow on top.
Can we keep our existing payer portals?
Yes. The engine integrates with submission portals you already use (Availity, payer-direct, etc.) — it doesn't replace them.
How long is implementation?
3–5 weeks depending on payer count and platform. The first 2 weeks are payer-rule encoding; the rest is integration and rollout.
Will it work with our Medicaid MCOs?
Yes. The most common Texas, Louisiana, and southeast Medicaid MCOs are pre-encoded; new payers can be added as scope add-ons.
Care Plan?
18% of build fee per year — keeps payer rules current as MCOs change requirements.
Start with a free DME leakage audit
30-minute call. Irfan personally maps your intake → setup → resupply cycle and quantifies the leakage in dollars. No deck.
Book the audit Read the case study