Prior submits all your prior authorizations end-to-end. Our agentic stack handles intake, payer-specific medical-necessity reasoning, submission, peer-to-peer calls, and appeals — all under MD supervision and HIPAA BAA. You stop chasing payers. We do it.
No software to learn. No coordinator to hire. No payer portals to remember. Orders flow in, decisions flow out — under MD supervision, with full audit trail. We are agentic services, not software.
Every PA reasoned against the latest payer-specific medical-necessity policy. Targeting 75%+ first-pass approvals on top procedure codes.
Peer-to-peer scheduling, follow-ups, status checks, appeals — handled by us. Your team stops dialing payer hold lines.
Reclaim clinician time AMA 2024 says is lost to PA paperwork. Time that should be clinical, not administrative.
The 2024 AMA physician survey, replicated across 1,000 practices, paints the same picture every quarter. Small specialty practices are hit hardest — they have the volume of a hospital but the staffing of a clinic.
Lost to prior authorization work — phone calls, portal logins, faxes, peer-to-peer scheduling. Time that should be clinical.
PA-induced delays don't just frustrate patients. AMA 2024 reports 29% of PA-delayed cases lead to clinically significant adverse events.
Patients give up on prescribed care because the PA process is unmanageable. The practice loses revenue and the patient loses outcome.
Prior is agentic services, not software. You don't log in and click "submit." Orders flow into our system from your EHR, fax, or email. Our four-layer stack handles them, with a Clinical Lead reviewing every escalation and an MD signing every appeal.
Fax, email, EHR push, or upload — however your practice already operates. We extract CPT, ICD-10, MD, and payer with 95%+ accuracy on top codes.
Every PA reasoned against payer-specific medical-necessity policy — UHC, Aetna, Cigna, BCBS, Humana, Kaiser, and 500+ more. Our payer runbook library updates with every submission.
Offshore RN/LPN reviewers check 10–15% of submissions and 100% of high-risk procedures. Onshore Clinical Lead handles escalations. MD signs every appeal.
Availity FHIR, NaviNet, payer portal, or fax — whichever channel works for that payer. Peer-to-peer calls included. Status pushed back to your EHR in real time.
Service contracts are scored on what they deliver — not how many users log in. Here's what Prior is built to produce, and how we measure it.
On the top 50 procedure codes per specialty. Industry baseline runs 50–60%. Every additional point compounds — fewer appeals, faster patient care, less revenue stuck in receivables.
Implementation contracts in healthcare typically run 6–12 months. We are designed for the 1–10 MD specialty practice — fax, email, EHR push, or upload. No IT calls.
Manual processing runs $14–$40 per PA across staff time and rework. Claude Sonnet 4.5 with prompt caching and batch API drives our marginal cost to $0.30 — the math finally works.
What AMA 2024 measured as the average physician PA burden. That's 670 hours per year per MD — clinical time we hand back, not save in software.
Outcome-based reporting: every customer gets a monthly scorecard with first-pass rate by payer, average time-to-decision, denial reasons taxonomy, and appeal overturn rate. We hold ourselves to numbers, not feature releases.
PA automation is crowded — but every well-funded player optimizes for someone else. Hospitals. Payers. Epic shops. We're the only stack purpose-built for the 1–10 MD specialty practice that doesn't have an IT team and can't wait on a 9-month enterprise rollout.
Cohere ($5.5B valuation) is a payer-side automation tool. They sell to UnitedHealthcare and Humana to deny PAs faster. Their incentive is to reduce approval rates.
Prior is provider-side. Our incentive is your first-pass approval rate and your throughput. Every line of code is written to get your patient covered.
Tennr ($605M valuation) is a referral and intake orchestration platform. It can submit some PAs, but its core surface is referrals and patient routing — not PA reasoning, peer-to-peer, or appeals.
Prior owns the full PA lifecycle. Reasoning against payer policy, submission, peer-to-peer voice agent, denial appeals — under one MD-supervised SLA.
Humata partners with Optum, Allegheny Health, and CMS. Their wins are 200,000-PA/year health systems. Implementation requires Epic, IT teams, and multi-quarter rollouts.
Prior fits the 1–10 MD practice that Humata doesn't sell to. Live in 5–7 days from BAA. Any EHR. No IT. Per-physician retainer, not enterprise contracts.
Waystar and Availity are revenue-cycle platforms that route PA forms through clearinghouses. Your staff still fills them out, attaches the records, and chases the status.
Prior is agentic services, not software. Your staff doesn't log in. Orders come in, decisions go out. We absorb the work, not just the form.
Prior is a fully managed service, not a software subscription. Engagements scale by your PA volume, payer mix, and SLA — not by seats. Pricing is custom and discussed on the introductory call.
Single specialty getting their first PA workflow handed off. 48-hour SLA, standard payer coverage.
Multi-specialty groups ready to scale PA throughput. 24-hour SLA, full payer coverage, peer-to-peer voice.
Ambulatory surgery centers and large multi-specialty groups. 8-hour SLA, custom payer additions, dedicated CSM.
Prior authorization has been broken for years. What changed in 2026 is that the technology, the regulation, and the labor market all bent the same direction at the same time.
Effective January 2026: 72-hour expedited and 7-day standard PA decisions for MA, Medicaid, and ACA plans. Plus FHIR APIs by January 2027. Practices with no IT staff need a partner.
Claude Sonnet 4.5 with prompt caching and batch API drives marginal cost per PA to $0.30 at scale, vs. $14–$40 manually. The math finally works.
300K+ clinical-admin staff exited the profession 2019–2022. Practices can't staff PA coordinators at prevailing rates. They need a service, not a hiring drive.
Every vendor has a signed BAA. Every PA has an audit log entry. Every appeal carries an MD signature. We treat HIPAA, SOC 2, and HITRUST as non-negotiable engineering surfaces — not paperwork.
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