The prior authorization value case

What unmanaged prior authorization costs a practice, measured against the national picture — and what Praxigen does about each lever.

Unmanaged prior authorization costs a practice two separate ways. A · Revenue at risk — reimbursement lost on denied PAs that are never appealed. B · Admin cost burned — staff and clinician time spent doing PAs, appeals, and peer-to-peers. These are different dollars; we never add them together.

A · Revenue at risk

Revenue at risk / year

$771,120

denied PAs never appealed × revenue × 12

Winnable on appeal / year

$630,005

that risk × AMA 81.7% overturn rate

Modeled for

Orthopedics / Sports Med

120 PA/mo · 18% denied · 85% dropped · $3,500/proc

B · Admin cost burned — net savings / physician / year

~$40,775/physician/yr in staff time alone — modeled up to ~$79,790 with fewer denials and reclaimed clinician time. Lead with the floor: it rests only on time-per-PA × volume × loaded wage. Praxigen is $299/mo ($3,588/yr, flat), so even the floor is ~11× the fee.

Layer 1 · Time floor

Ironclad

~$40,775

PA submission labor only. No denial-rate claim, no opportunity cost.

Layer 2 · + Appeals

Modeled

~$61,903

Adds fewer denials and lower appeal cost.

Layer 3 · + P2P time

Modeled

~$79,790

Adds reclaimed peer-to-peer time at $500/hr foregone billing.

Modeled for a single-physician orthopedic practice at the conservative end of the PA denial band (18%; band 14–22%). Per physician — the $299/mo fee is flat per practice, so multi-physician practices have better ROI. The 3-minute Praxigen handling time is early-testing (internal), and the denial-reduction and $500/hr opportunity-cost inputs are modeled, not yet customer-measured.

You vs the national picture

Lever	National	What Praxigen does
PA denial rate, procedural specialties	14–22%	Note Checker flags documentation gaps before submission
of physicians always appeal a denial	~18%	Drafts the policy-grounded appeal so denials get filed, not written off
of appealed PA denials are overturned	81.7%	The winnable upside Praxigen helps you capture
prior auths per physician, per week	~39	The workload Praxigen absorbs per provider
physician + staff time on PA, per week	~13 hrs	Appeal + note drafting drop from hours to minutes

Modeled revenue at risk by specialty

Specialty	PA / mo	Denied	$ / proc	Risk / yr	Winnable / yr
General / Multi-specialty	100	12%	$1,200	$146,880	$120,001
Orthopedics / Sports Med	120	18%	$3,500	$771,120	$630,005
Pain Management	180	20%	$1,500	$550,800	$450,004
Spine / Neurosurgery	60	22%	$9,000	$1,140,480	$931,772
Radiology / Advanced Imaging	400	15%	$1,100	$712,800	$582,358
Cardiology	90	14%	$2,800	$359,856	$294,002
Gastroenterology	110	12%	$1,800	$242,352	$198,002
Physical Therapy / Rehab	150	18%	$600	$174,960	$142,942
Dermatology	80	14%	$900	$102,816	$84,001

What we measure in the pilot (month-2 report)

Turnaround

Hours from case opened to PA submitted, days submitted to decision

First-pass approval rate

Approved with no interim denial, from logged status events

Denial & approval rate

On the practice’s own cases, decided vs total

Hours saved + ROI

Baseline minutes/PA minus our turnaround, × volume × staff wage vs the fee

Adoption & use rate

Cases run through Praxigen vs PA volume; drafts generated vs exported

Above are modeled estimates from national rates and your inputs. The pilot replaces them with your practice’s own measuredresults — we don’t promise an approval rate.