Prior Authorization Readiness & Revenue Exposure Model

What is your paperwork costing you?

Answer what you know. Mark what you don’t. The model runs either way — and the number of things you had to leave at benchmark is, in our experience, the more useful of the two answers on this page.

HIPAA COMPLIANT•BAA AVAILABLE•HL7 FHIR•NVIDIA INCEPTION MEMBER
Part One

Intake Readiness

Five dimensions, 0 to 3 each. A low score is not a failing grade — it means the problem is currently invisible, which is worth knowing before anyone spends anything.

Volume visibility—

Do we know how many documents arrive here in a month?

Detection point—

Who finds the defect first — us, or the payer?

Rework load—

Do we measure how often a document is re-touched?

Attribution—

Can we trace a denial back to the field that caused it?

Change readiness—

Is there a route to test something without a full procurement cycle?

Part Two

Your Numbers

If a figure isn't known, tick don't know and the model substitutes a published benchmark. Benchmarked figures are flagged in the result.

Documents received per monthReferrals, orders, certifications, prior auth packets — every department, every fax line.
benchmark
Average reimbursement per orderYour highest-volume service line is close enough.
$
benchmark
Initial denial rateShare of claims denied on first submission.
%
benchmark
Share of denials caused by documentationRather than medical necessity — a missing signature, a code that doesn't support the diagnosis.
%
benchmark
Share of orders needing a second touchAnything that comes back for one more field before it can go out.
%
benchmark
Minutes lost per re-touched orderChasing the practice, re-keying, resubmitting.
min
benchmark
Fully loaded coordinator costSalary plus benefits, per hour.
$/hr
benchmark
Share of denials actually appealedMany are written off instead of worked.
%
benchmark
Model assumptions — adjust or challenge any of these▼
Appeal overturn rateOf the denials you do appeal, the share eventually paid.
%
Cost to work one appealStaff time, resubmission, follow-up. MGMA published figure.
$
Defects caught at intakeThe share of documentation defects a validation layer surfaces before submission.
%

This page performs arithmetic on figures you supplied. It is an estimate, not a forecast, and not a guarantee of any result. Benchmark defaults are drawn from published industry sources (AHA prior authorization survey; MGMA cost-per-appeal data) and will not match any specific organization. Nothing entered here leaves your browser.

Readiness Score
0/ 15

Complete all five dimensions for a detailed readiness evaluation.

Annual Exposure at Intake
$262,466

About 53 preventable defects a month at 1,200 documents.

Revenue never recoveredPreventable denials, net of appeals won
$194,262
Cost of appealingStaff time spent fighting what could be caught
$33,644
Rework at intakeSecond touches, chasing signatures
$34,560
Total annual exposure$262,466
Modelled protected revenueAt a 60% catch rate — adjust in assumptions
$157,480
DocuFindr platformEssentials tier · $2,500/mo
$30,000
Modelled net$127,480
CONFIDENCE — LOW

8 of 8 figures are benchmarks, not yours. This is a hypothesis, not a business case — and that is the finding. Nobody can currently tell you what documentation is costing this organisation. Four weeks of your own document flow would settle it, at no cost.

DocuFindr Inc. · docufindr.aiWorking at the signature, not the appeal.

Interested in a custom ROI analysis for your specific operation?Contact our strategy team