Prior authorization,
Approvals faster, with less staff time. One source-grounded workflow, no EHR integration.
See it on your toughest case.
Bring a denied or tricky prior auth (de-identified). We'll show you the payer criteria and the evidence behind it, live.
No spam, ever.
This is the actual interface. Six tools that take a prior auth from requirements lookup to cited appeal, in one place. Click through them below.
Prior-auth knowledge is scattered across thousands of payer policies, clinical studies, and shifting state and federal rules. Praxigen continuously maps them into one queryable layer, so every answer is retrieved from a cited source, never invented.
Every answer is traceable
Each recommendation links back to the payer policy, regulation, or study it came from. No black box.
It stays current
Automated jobs watch the Federal Register and payer policies, so requirement changes are caught, not missed.
No fabrication
Evidence comes from real, cited studies and published policy. If a source does not support it, we do not claim it.
Lookup, note-checking, appeals, pre-claim checks, and analytics. One workflow, no tab-juggling across payer portals and spreadsheets.
Know what the payer requires.
Check payer requirements for any procedure or CPT code across 61 payers with sourced rules, before you submit.
A denial engine that gets smarter every month.
Every note check and appeal is grounded in real, cited clinical-trial evidence mapped to each payer's published criteria, not generated from memory. Praxigen also tracks the exact language that gets approved versus denied across every case and payer, then feeds it back in. The more your team uses it, the harder it is for payers to say no.
Every role on a practice's prior-auth workflow gets the view that fits their job.
Office & practice managers
See every auth, deadline, and denial pattern at a glance, and put a number on the time your team gets back.
PA specialists & MAs
Check the note against the payer’s own criteria before you submit. No more guessing what they want.
Billing & RCM teams
Catch auth-vs-claim mismatches before the claim drops, and turn denials into cited, policy-targeted appeals.
Why we’re building this.
We interviewed prior-auth staff, billers, and practice managers before we wrote a line of code. This is what we kept hearing.
“You have patients that suffer for a year waiting for this authorization.”
“I have two computer screens with all the stuff open just to get one auth through.”
“I sit on the phone for hours just trying to see if there’s a prior auth on file.”
“The appeals process with Praxigen was amazing.”
Two appeals drafted in Praxigen, both denials overturned. Dr. Diaz counts 24 visits put back on his patients’ plans — his number, from his records, not ours. He is still using it.
That is one practice. We will publish more results as we have them, and no one can guarantee a payer’s decision.
Say a practice runs 100 prior authorizations a month.
About 12% come back denied. That’s 12 a month.
And 85% of those denials are never appealed. 10 written off, every single month.
in care you already delivered, simply never resubmitted.
Your practice
Run the math on your practice
Choose your specialty for a starting estimate, then adjust any number to match your practice.
The AMA finds 80.7% of appealed prior-auth denials are overturned, so most of this is winnable. Praxigen targets it directly: flagging documentation gaps before submission so fewer PAs are denied, and drafting policy-grounded appeals so denials do not get dropped.
Estimate only, for illustration. Not a guarantee of results or approvals. Default assumptions are anchored to published research; specialty presets are typical starting points to adjust to your own data. Denial rates: the U.S. initial claim denial rate was ~11.8% in 2024 (Kodiak Solutions revenue-cycle data, ~2,100 hospitals and 300,000 physicians), an all-claims figure used here as a general starting proxy; for prior authorization specifically, orthopedic ASC cases commonly run 14–22% and interventional pain procedures around 20%. Per-specialty denial presets outside those are typical-range estimates, not exact figures. Most denials are never appealed (the 2024 AMA Prior Authorization Physician Survey found fewer than 1 in 5 physicians, 18%, always appeal), yet of the denials that areappealed, 80.7% were fully or partially overturned in Medicare Advantage in 2024 (KFF analysis of CMS data; only 11.5% of MA denials were appealed at all). PA volume is anchored to the AMA finding of ~39 prior authorizations per physician per week (practice totals scale with the number of providers). “Revenue at risk” = denied PAs never appealed × average procedure revenue, and excludes delayed approvals, staff time, and patient attrition. Revenue per procedure varies widely by specialty and payer, so enter your own.
Where Praxigen moves the needle
Your numbers above, against the cited national picture.
Nationally, fewer than 1 in 5 physicians always appeal a denial (AMA). Praxigen drafts the policy-grounded appeal, so far more get filed instead of written off.
Procedural specialties commonly run 14–22% (orthopedic ASC; ~20% interventional pain). The Note Checker flags documentation gaps before submission so fewer are denied.
Winnable revenue = the revenue at risk above × the 80.7% Medicare Advantage appeal-overturn rate (KFF, 2024 — the share of dropped denials that would be overturned if pursued; MA is the best national PA dataset and other markets overturn less). Directional estimate, not a guarantee.
See the full value breakdown for these numbers →And that’s only the cost of standing still. The value of fixing it is the bigger number: winnable revenue recovered, denials headed off before they happen, and your team’s hours back.