Our clients succeed because we fix what others miss:

Dynamic Payer Rule Engines: While others use static rules, we embed AI that learns from denials (e.g., UHC’s July 2024 modifier requirements) and auto-updates PA logic across Health Cloud.

Denial-Proof Documentation: Off-the-shelf tools miss subtle triggers like missing LOINC codes or incomplete clinical narratives. We train Einstein GPT to draft audit-ready PA requests using your top specialists’ writing patterns.

Patient-Specific Risk Mitigation: 62% of denials stem from patient-side issues (e.g., outdated insurance). Our Health Cloud layer cross-references coverage, SDOH data, and appointment history to preempt denials before submission.

The Lean IT’s Difference: How We Turn Prior Auths into Profit

1. “Set-and-Forget” Payer Policy Management

Forget manually tracking 100+ payer guidelines. Our Policy Sync Engine within Health Cloud:

Automatically ingests payer bulletins, CMS updates, and plan-specific PA criteria.

Flags conflicts between your EHR’s clinical notes and payer rules (e.g., “Aetna requires HbA1c >8% for GLP-1 approvals—documentation missing”).

Result for Clients: A Midwest hospital system slashed denials by 58% in 90 days.

2. White-Glove Patient Advocacy at Scale

Patients abandon care when PA delays strike. We bake automated patient advocacy into Health Cloud:

AI identifies high-risk cases (e.g., cancer patients) and triggers VIP handling:

Dedicated care navigators assigned automatically.

Real-time PA status pushed to patient portals and providers’ mobile devices.

Outcome: A specialty pharmacy reduced patient drop-offs by 33% while handling 2x volume.

3. Denial-to-Revenue Recovery Pipeline

Even with automation, 10-15% of PAs get denied. Our Revenue Rescue Module in Health Cloud:

Uses NLP to analyze denial reasons and auto-generate appeals with 90%+ accuracy.

Prioritizes high-value claims (e.g., $10k+ procedures) for urgent rework.

Client Impact: A radiology group recovered $2.8M in previously written-off revenue last fiscal year.

Why Health Systems Partner with Us (Not Our Competitors)

We Solve the “Last Mile” Problem Others Ignore

Most Health Cloud projects stall at EHR integration. We go further:

Deep Epic/Cerner Integration: Auto-pull progress notes into PA forms while redacting non-relevant PHI.

Payer API Mastery: We’ve built connectors for 150+ regional and national payers—no more portal-hopping.

Staff Adoption Guarantee: Our change management team trains your staff using real denied claims from your data—not hypotheticals.

Metrics That Matter to Your CFO

85%+ First-Pass Approval Rate: Achieved for 94% of clients within 6 months.

12-Minute Average PA Handling Time: Down from 4 hours pre-automation.

27 ROI for Every 1 Spent: Based on reduced denials, staff savings, and revenue recovery.

“We Tried Automation Before—What Makes You Different?”

A regional health plan asked us this. Within 12 weeks, we:

Replaced their patchwork of RPA bots with a unified Health Cloud PA hub.

Trained AI on their 18-month denial history to predict and block 73% of avoidable errors.

Delivered: $4.2M annualized savings and a 22% increase in provider satisfaction scores.

Their CMO’s Verdict: “This isn’t IT—it’s a revenue cycle revolution.”

Your Next Steps

Discover Your PA Leakage Score: [Take Our 2-Minute Assessment]

How much revenue are denials costing you?

Where are your staff’s hidden inefficiencies?

Pilot Our System Risk-Free:

Let’s automate PA for your highest-denial service line (e.g., infusions, imaging). Pay only if we cut denials by 40%+ in 60 days.

Act Now—2024’s Biggest Payer Changes Are Coming:

Without adaptive automation, your denials could spike 30% by Q3.