Get scheduled cases to the OR — with the docs to get paid.
Approva runs prior authorization for orthopedic and pain ASCs. 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.
What it does
Built around how ASC prior auth actually works.
Case-first
The Case, not the claim
Every view centers on a scheduled surgery — patient, procedure, payer, date, dollars at risk, what's outstanding.
The Packet
Payer-specific from the chart
A complete bundle: cover sheet, codes, evidence index, medical necessity narrative, and the payer's submission form — assembled automatically.
Criteria-led
The argument, not just the code
The Criteria Checklist is the headline. Codes are a section of the packet, not the lede. Gaps cite the rule they're against.
CMS-0057-ready
Built for the 2027 mandate
Electronic prior authorization, FHIR-based submission, and response handling — built for the world the federal mandate creates.
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.
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 human in the loop
Every Case audited by a certified reviewer before it goes out.
Approva's reviewer team — CPMA and CASCC coders, UR nurses, and a fractional physician advisor for peer-to-peer escalations — audits every Packet before submission. Reviewers fix gaps, capture denial reasons, and sign off on the argument.
Every AI confidence reading is paired with the name of the reviewer who audited it. The system proposes; a credentialed human signs.
One certified reviewer signs every Packet. One payer response refines every rule.
Capability
Three views that change how your team works.
Criteria checklist
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 criterion cites the payer policy it's scored against.
Documentation gaps
Every gap comes with a fix.
Every documentation gap cites the rule it's against and offers a concrete next step — from the chart, an RFI, or a peer-to-peer. The team doesn't have to know the payer policy; Approva surfaces it with the action attached.
The Packet
The Packet a reviewer can sign.
Every Packet is a complete, payer-specific bundle: cover sheet, codes, evidence index, medical necessity narrative, and the payer's required form. A certified reviewer signs off before it leaves the building. The packet carries the reviewer's name — not just the AI's confidence score.
Why it works
Built for the workflow, the regulation, and the PHI.
Industry reality
88% of physicians describe PA burden as high or extremely high.
The AMA's research is consistent: prior authorization consumes physician and staff time at a rate that directly affects patient access and practice economics. Approva is designed for the load this creates at an ASC — not after it, not around it.
Regulatory alignment
CMS-0057 and timely-filing windows.
The 2027 federal prior authorization rule mandates electronic submission and fast response windows. Approva is designed for FHIR-based ePA. Timely-filing windows are tracked and surfaced in the work queue — no case expires unnoticed.
PHI and compliance
HIPAA-aligned, BAA-ready, multi-tenant from day one.
Approva handles PHI under the HIPAA Privacy and Security Rules with access controls, audit logging, and encrypted transmission. Approva signs a BAA as part of every engagement. See our security posture → · BAA →
The Dashboard
Every case you authorize flows into the Dashboard →
Every authorized, denied, appealed, and collected case becomes visible in Approva's revenue command center — so the intelligence compounds and the billing team works from a single picture of the business.
See the Dashboard →FAQ
Frequently asked questions
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.