The AI reads the clearance analysis and drafts the whole payer packet — CPT + ICD-10, medical necessity narrative, documentation checklist, peer-to-peer talking points. Your coordinator reviews, tweaks, and pastes into the payer's portal.
Insurance companies require Prior Authorization before elective spine, joint, bariatric, plastic reconstructive, sleep-apnea, and hernia-with-mesh cases. Every payer has a different form. Every denial takes a week to come back. And 80% of denials are because ONE document was missing.
After MyPreOp analyzes the chart for pre-op clearance, it already has the diagnosis, comorbidities, failed conservative treatment, and clinical justification captured in the two-section PDF. One click turns that into a payer-ready packet.
The clearance is already done. Scroll to the Prior Authorization panel and click Generate packet.
Procedure CPT. Principal ICD-10 + secondary ICD-10s for comorbidities. Medical necessity paragraph in the surgeon's voice. Documentation checklist with green/amber flags. Peer-to-peer talking points.
Every code has a Verify flag when the AI is less than confident. Every paragraph is editable. The doc checklist tells you what's missing BEFORE you submit — so a denial never lands.
One-click copy for CPT, ICD-10, and the necessity narrative. Works with BCBS, UHC, Aetna, Cigna, Humana, Medicare Advantage — any payer's portal. No integration required.
If the payer wants a physician-to-physician review, the talking points are already in the packet, keyed to your patient's specific comorbidities and clinical story.
Coordinator spends an hour filling in the BCBS portal, plugs in CPT 27447 + ICD-10 M17.11, writes a generic paragraph, uploads MRI + PT notes + injection records. Submits. Denied 7 days later — no documented weight-loss counseling for BMI ≥ 40 (a real BCBS carve-out). Goes back to the PCP, gets a note added, resubmits. Another 7 days. OR date passes. Patient is rebooked.
Surgeon opens the patient, clicks Generate packet:
Coordinator sees the gap BEFORE submitting. Calls the PCP, adds the note, submits clean. Approved on first pass. Case stays on the schedule.
Practice tier is $499/mo. A rebooked total-knee OR slot costs the ASC real money in room turnover, wasted staff time, and rescheduling headaches. Prior Auth is one of four enterprise revenue-cycle features bundled at that tier — alongside Billing-Ready Codes, MIPS Quality Reporting, and Risk Adjustment / HCC.
No — no tool does. Every payer has its own portal and process. What we do is DRAFT the packet so your coordinator's 45-minute job becomes a 5-minute review-and-paste. The submission still happens through your PA coordinator in the payer's system.
Perfect — this makes them faster. Every code has a Verify flag when the AI isn't confident, so your coder still owns the final decision. The AI just eliminates the blank-page problem: your coder starts with a 90%-there packet instead of typing from scratch.
Yes. Prior Auth generation runs through AWS Bedrock (Claude on our HIPAA-eligible enterprise tier). PHI never leaves the AWS BAA. Every AI call is rate-limited and gated to enterprise (Practice tier) accounts.
All of them. Because we don't integrate directly with payer portals, the tool works with BCBS, UHC, Aetna, Cigna, Humana, Medicare Advantage plans, workers' comp, and any commercial payer. Your coordinator copies each block into the portal they already use.
Never. Every packet is an AI DRAFT that a licensed provider or certified biller must verify and edit. The medical necessity narrative is written in the surgeon's voice but the surgeon owns the final wording. The tool is decision-support, not a submission robot.
Prior Authorization is part of the Practice tier. Sign in with your MyPreOp account or start a Practice subscription to unlock it.