Prior authorization for ambulatory surgery centers
Approva handles the full prior authorization lifecycle — from chart-to-packet assembly through payer submission and decision tracking — for orthopedic, spine, and pain ASCs.
Chart-to-packet assembly
When a case is scheduled, Approva automatically pulls the relevant clinical documentation — diagnosis codes, imaging reports, prior conservative treatment history, and surgeon notes — and structures it against the specific payer's coverage criteria. Packets are built to match payer requirements before submission, not revised after denial.
Certified reviewer audit
Every packet is reviewed by a certified authorization specialist before it leaves the system. Reviewers check clinical completeness, confirm that documentation meets payer criteria, and flag any gaps that could cause a technical denial. The goal is a clean, complete submission on the first attempt.
Payer submission and real-time tracking
Approva submits to payers through their preferred channels and tracks authorization status in real time. Stalled cases are flagged for follow-up. Approved authorizations are confirmed against the scheduled procedure. Denials are automatically routed to the denial management workflow or, where appropriate, to a peer-to-peer review. Every case status is visible in one place — no phone queues, no manual tracking spreadsheets.