Assemble
The engine reads the order and chart, pulls the qualifying notes and imaging, matches the payer's policy, and builds a complete submission packet with the codes attached.
Live payer status · 214 auths in flight
Clear the prior-auth queue — before the denials land
PriorPilot auto-assembles and submits every prior-authorization, scores its denial risk before you send it, tracks the payer, and drafts the appeal when a decision goes the wrong way — one triaged queue instead of fax, phone and hold music.
- 88% first-pass approval
- Denial risk before you submit
- Appeals drafted for you
88%
first-pass approval
0target 85100
MRI
Approved
CT
Info
ECO
Appeal
PSG
Denied
Approved
Info requested
Appeal
Denied
0
Auths in flight
0%
First-pass approval
+3 pts
0
Avg turnaround (days)
faster
$0K
At risk in open denials
in appeal
Why auths get denied
A denial is rarely a surprise. It's a checklist you missed.
Most denials trace back to a handful of fixable gaps. PriorPilot learns each payer's rules and flags the missing piece before you submit — so the request goes out complete the first time.
Medical necessity not established
High
Conservative-care history or the qualifying indication isn't documented the way the payer's policy requires.
Missing clinical docs
Medium
Imaging, chart notes or lab results referenced in the order never made it into the submission packet.
Out-of-network referral
Medium
The referring or rendering specialist sits outside the member's plan network for the requested service.
CPT / diagnosis mismatch
Low
The ICD-10 diagnosis doesn't link cleanly to the procedure code, or a more specific code is required.
Every risk score, fully attributed
PriorPilot doesn't just say "high risk." It shows the weighted reasons behind the score — the exact gaps to close before the auth goes out. Here's one echocardiogram request flagged at 71/100.
71
/ 100
- Prior imaging < 12 mo 41%
- Diagnosis specificity 29%
- Symptom onset undated 18%
- Payer base denial rate 12%
From order to outcome
Assemble it. Predict it. Recover it.
PriorPilot runs the whole prior-auth lifecycle — pulling the packet together, scoring denial risk before submission, and drafting the appeal if a payer says no.
Predict
A denial-risk model scores each auth 0–100 before it's sent, attributes the risk to specific gaps, and tells your team exactly what to fix to clear the payer first time.
Recover
When a payer denies, PriorPilot drafts a citation-backed appeal, re-codes where needed, and routes it to peer-to-peer — all before the deadline window closes.
Inside the product
The whole queue, and the file behind one auth.
BuildspaceLabs built the MVP front end: an Authorization Queue for triage across payers, and a per-authorization detail view for working a denial and its appeal.
Authorization Queue
Triage every payer in one worklist.
First-pass approval, turnaround and denial exposure sit above a status-coded table — so the auths that need a human land on top, worst-first.
- 12-month first-pass approval trend rising to 88%
- Requests coloured by status: approved, pending, info, denied, appeal
- Top denial reasons and per-payer approval rates on the rail
Authorization detail
Everything on one auth — down to the appeal.
A status timeline, the AI-extracted clinical justification with chart citations, a weighted denial-risk score, and a drafted appeal with sequenced next actions.
- Assembled → Submitted → Review → Decision → Appeal timeline
- Clinical justification pulled from chart notes, with citations
- A 71/100 denial-risk score and a 79%-overturn appeal draft
What's in the box
Built for the revenue-cycle workflow, end to end.
Intake, submission, denial prediction and appeals consolidated into one prior-auth surface — nothing left on a fax cover sheet.
Authorization Queue
A single worklist across payers with first-pass, turnaround and denial-exposure KPIs above a status-coded table.
Denial-risk score
A 0–100 denial probability per auth, computed before submission and refreshed as documents change.
Auto-assembled packets
The order, chart notes, imaging and codes pulled together into a payer-ready submission, no manual collation.
AI-drafted appeals
Citation-backed appeal letters with the winning argument, re-coding suggestions and a peer-to-peer path.
Live payer tracking
Each request's status — submitted, in review, info requested, decided — updated across every payer in one place.
Denial & payer analytics
Top denial reasons and per-payer approval and turnaround, so the recurring gaps get fixed at the source.
Explainable, not black-box
A risk score your billing team will actually trust.
A denial score nobody understands gets ignored. PriorPilot shows the weighted gaps behind every score and cites the payer policy it's matching against — so the recommendation carries its own justification.
- Every score decomposes into named, weighted denial drivers.
- Justifications and appeals cite the chart note and the payer policy.
- Real-time denial exposure across all 214 auths in flight.
Denial-risk · auth PA-2026-04871
71
Prior imaging < 12 mo
41%
Diagnosis specificity
29%
Symptom onset undated
18%
Payer base denial rate
12%
Under the hood
Modern data stack, production-grade front end.
Delivered as a production-quality MVP in a nine-week engagement.
Next.js
React
TypeScript
Tailwind CSS
FastAPI · Python
PostgreSQL
FHIR / HL7 intake
Clear your prior-auth queue — with fewer denials.
We build AI-native products like PriorPilot. Tell us about your revenue-cycle motion and we'll show you what a denial-predicting, appeal-drafting queue looks like on your payers and your codes.