Get scheduled cases to the OR — with the docs to get paid.
Prior authorization for ambulatory surgery centers — orthopedic, spine, and pain.
Approva runs prior authorization for ambulatory surgery centers. AI assembles a payer-specific medical necessity packet from the chart; certified reviewers audit every case before it goes out; payer responses train the system.
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.
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.
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 begin, Approva is finished.
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.
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.
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.
- Median time to first auth
- −1.2d
- vs. ASC baseline · n=4 sites · Q1 2026
- First-pass approval rate
- +18%
- orthopedic + spine cases · 12-week window
- At-risk exposure recovered
- $48,200
- avg. per site per month · case-level audit
"By the time the surgeon walks in Monday, we already 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."
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.
One platform. Three artifacts.
Approva is organized around the three things that have to happen for an ASC to get paid for a scheduled case. Each is an artifact a reviewer can sign — not a workflow that runs in the background.
The Packet
A payer-specific medical necessity bundle: cover sheet, codes, evidence index, narrative, form. Reviewers audit every Packet before it goes out. The Criteria Checklist is the headline; codes are a section.
Learn moreThe Appeal
When a case is denied, Approva parses the denial reason, maps it to the criterion it was scored against, and routes the case — RFI response, peer-to-peer, or formal appeal. Every denial trains the rules library.
Learn moreThe Conversation
Approva schedules peer-to-peer calls with payer and UM-vendor medical directors, generates the briefing material from the chart and denial letter, and stamps the outcome back into the case.
Learn moreFrequently asked questions
What is prior authorization for ASCs?
Prior authorization is the process by which a payer approves a procedure before it is performed. For ambulatory surgery centers, it applies to scheduled surgical cases — orthopedic, spine, pain management, and others — before the case can proceed and be reimbursed.
Which specialties does Approva cover?
Approva handles prior authorization for orthopedic, spine, and pain management ambulatory surgery centers. These specialties have high prior authorization volume and significant denial risk, making authorization workflow a core revenue cycle function.
Which payers does Approva work with?
Approva handles authorization across major commercial payers and Medicare Advantage plans. Payer-specific packet requirements and documentation rules are built into the workflow.
What is CMS-0057 and what do ASCs need to do?
CMS-0057-F is the CMS Interoperability and Prior Authorization final rule, which requires covered payers to implement FHIR-based prior authorization APIs and meet new decision timeframes by 2026–2027. ASCs are not directly regulated, but the rule changes how payers respond to requests your center submits. See our full CMS-0057 guide for details. Learn more →
Is Approva HIPAA-compliant?
Yes. Approva operates under a Business Associate Agreement (BAA) and handles protected health information in compliance with HIPAA requirements.
Does Approva sign a BAA?
Yes. A Business Associate Agreement is part of every Approva engagement. You can review our security and compliance posture at our security page. Learn more →
Does Approva replace our authorization staff?
No. Approva augments your existing team. Certified human reviewers audit every case before submission. The system handles packet assembly and payer-specific formatting; your staff and our reviewers handle judgment and escalation.
How long does implementation take?
Most ASCs are live within two to four weeks. Implementation includes EHR/PM system connection, payer rule configuration, and a review of your current authorization workflow.
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.