From scheduled case to collected payment.
AI assembles the medical-necessity packet, certified reviewers audit every case, and the dashboard shows every dollar from the OR to the bank.
Who it's for
Built for orthopedic and pain management ASCs.
The high-volume specialties where prior authorization is a daily bottleneck — and where the medical necessity argument is the bottleneck inside it. Approva is designed to compress the prior-auth cycle from weeks to days, with a Payer Rules Library encoding the criteria that matter most for surgical cases.
Designed for
Orthopedics, spine, pain management
The wedge specialties Approva covers from day one. Adjacent specialties added as the rules library grows.
Built around
Hundreds of payer policies
Aetna, BCBS, UnitedHealthcare, Cigna, Humana, regional Blues, Medicare Advantage. Plus the major UM vendors that handle delegated decisions.
Aligned with
CMS-0057 mandate
The 2027 federal prior authorization rule reshapes the industry. Approva is built for the world the mandate creates.
What makes Approva different
Different stage of the revenue cycle. Different artifact.
Coding vendors run after the procedure on finalized notes. Approva runs before the procedure on incomplete records — assembling the medical necessity argument that gets the case approved and paid.
01 / Stage
Pre-encounter, not post-encounter
Approva works between the moment a surgeon's office sends a case to the ASC and the moment the payer issues an authorization. By the time other vendors start, Approva's done.
02 / Object
The Case, not the claim
Every view in Approva centers on a scheduled surgery — patient, procedure, payer, date, dollars at risk, what's outstanding. Schedulers and admins don't think in claims. Neither does Approva.
03 / Artifact
The Packet, not the code
Approva assembles a payer-specific bundle: cover sheet, codes, evidence index, medical necessity narrative, form. The Criteria Checklist is the headline. Codes are a section of the packet, not the headline.
A case in Approva
See the argument, not just the code.
Your team sees "5 of 6 Aetna criteria met, 1 needs documentation" before they see a CPT code. That's how a scheduler knows what to do next, and how a reviewer knows what to fix.
Every gap comes with a citation to the rule it's against — and a suggested fix from the chart, an RFI, or a peer-to-peer.
What this could mean for your ASC
Designed against the numbers that matter.
The AMA reports 88% of physicians describe prior authorization burden as high or extremely high. The gap between what surgical authorization should take and what it actually takes is where Approva does its work.
Design target
Days, not weeks
Approva is designed to compress the prior-auth cycle from a typical five-to-ten days to one or two — through automated packet assembly and reviewer-audited submission.
Design target
Higher first-pass approval
Designed for an 85%+ first-pass rate on orthopedic and spine cases — through payer-specific Criteria Checklists and citation-backed medical necessity narratives.
Design target
Less revenue at risk
Designed to surface documentation gaps before submission and route denials to the right path — recovering the exposure that authorization friction normally costs an ASC.
These are the operational targets Approva is built to deliver. Your numbers depend on case mix, payer mix, and current baseline — we'll measure yours during onboarding.
By Monday morning, you know which Tuesday cases will get denied — and what's missing to fix them. The rule, the citation, the page in the chart. That's the whole job.
The Approva approach
How it works
AI proposes the Packet. Reviewers audit the argument.
Pure-AI ceilings out around 80% on medical necessity reasoning. Pure-services scales linearly with payroll. Approva does both — and uses every reviewer decision and every payer response as training signal for the next case.
The system
Document understanding reads the chart. The Packet assembler maps it to payer-specific criteria. The Payer Rules Library — built case by case — is a first-class data product. Every denial letter, RFI, and peer-to-peer outcome flows back as training signal.
The team
Every Case is audited by a certified reviewer — CPMA and CASCC coders, UR nurses, and a fractional physician advisor for peer-to-peer — before the Packet leaves the building. Reviewers fix gaps, capture denial reasons, and train the model.
01 · AI proposes
AI proposes
Document understanding reads the chart. Packet assembled against payer-specific criteria.
02 · Reviewer audits
Reviewer audits
CPMA + CASCC coder, UR nurse, fractional MD. Every Packet signed before it goes out.
03 · Payer responds
Payer responds
Approve, RFI, or deny. The denial letter is parsed and mapped to the criterion it failed.
04 · Model learns
Model learns
Reviewer fixes and payer responses become training signal. The rules library grows case by case.
The loop tightens with every case · One certified reviewer signs every Packet; one payer response refines every rule.
The platform
Two products. One revenue arc.
Approva covers the arc from a scheduled case to a collected payment. Prior Authorization gets the case approved and to the OR with the docs to get paid. The Dashboard shows an ASC — or a whole platform — every dollar in between, and the leakage worth recovering.
01
Prior authorization
Get the case approved
AI assembles the payer-specific medical-necessity packet; certified reviewers audit every case before it goes out; payer responses train the system.
Learn more →02
Dashboard
See and recover the money
Denials, underpayments, payer behavior, cases at risk, aging AR, and the revenue Approva puts back — across one center or a whole portfolio.
Learn more →From the front desk to the boardroom
Built for the team — and the people who own the number.
For the billing team
The pre-cert lead and the people working denials and AR every day. Sortable queues, drill-to-case, the email digest, and Ask Approva for plain-language answers about the book of business.
See the dashboard →For platform & PE leadership
The RCM director, CAO, or operating partner reading the health of one center — or every center. Leakage and recovery rolled up across sites: the value-creation view, in one place.
See the dashboard →FAQ
Frequently asked questions
The basics
Compliance & regulation
Working with Approva
The bottom line
Get cases to the OR. Get paid for them.
Less time on faxes. Fewer denials. A Packet behind every case that knows the rule it was scored against.