Clinical criteria match
Every required clinical criterion from the payer's medical policy is matched to evidence in the chart — diagnosis codes, lab values, prior therapy history, and contraindications.
The most rigorous prior authorization engine a specialty practice can use.
Specialty Prior Authorization Approval Engine assembles a documentation-complete prior authorization pack — every required clinical evidence element, every payer policy match, the submission-ready justification, and the appeal package — checked against the payer's medical policy and the patient's chart before a licensed clinical reviewer releases it.
Every payer medical policy, subsection-checkedFive statutory notice elements, gate-checkedDHSMV · USCG · UCC · judgment lien searchesSpecialist release on every pack5-business-day SLA
Why approvals fail
A single missing evidence element can deny a $30,000 treatment.
A specialty practice's prior authorization is only as strong as the documentation behind it. Miss a required clinical criterion, skip a payer-specific policy requirement, mis-time the submission window, or fail to include a supporting study — and the authorization is denied, delaying care and losing revenue.
Most practices run this by hand, from memory, across dozens of payers and drugs. The payer's medical policy has not been read end-to-end since the last denial. That is exactly where completeness gaps hide.
Specialty Prior Authorization Approval Engine exists to close that gap with a single, exhaustive standard applied identically to every file.
80.7%
of denials are overturned on appeal — but most never get a proper appeal
The benchmark
Measured against the payer's medical policy — criterion by criterion.
We do not summarize the policy and hope. Every pack is scored against a versioned rule pack tied to the exact text of the payer's medical policy. These are the provisions each pack is held to.
Electronic submission & timeline
Submission is routed through the payer's mandated API or portal, and the decision timeline is tracked against the 72-hour urgent / 7-day standard deadlines.
Every required recipient
The ordering physician, the practice's billing department, and the patient's insurance are all included in the communication chain — established by intake, not assumption.
Appeal-ready documentation
For any denial, a complete appeal package is assembled with the missing evidence, a clinical narrative, and a peer-to-peer request letter — all ready for the physician to review and sign.
Gold-card eligibility check
For states with gold-card laws (e.g., TX HB 3812), the practice's prior approval rate is checked; if eligible, the PA is flagged for exemption.
Step therapy & prior therapy
Step therapy requirements are documented, and any prior therapy attempts or contraindications are evidenced in the submission.
How a pack is built
Intake to specialist release, with deterministic gates the AI cannot overrule.
AI extracts and drafts. Deterministic rules — running as code, outside the model — decide what is complete. A licensed clinical reviewer signs every release. That order is never reversed.
01
Delinquency Gap Scan
Upload the order and patient chart. We return a free completeness read: which clinical criteria and payer policy elements you already have, and which are missing.
02
Evidence & policy matching
As your authorized clerical agent, we extract clinical evidence from the chart, match it to the payer's medical policy criteria, and build the evidence matrix.
03
Grounded drafting
The prior authorization justification is drafted from your validated data and the payer's policy into field-locked templates — no medical opinions, no invented facts.
04
Deterministic completeness gates
Clinical criteria are reconciled to the policy to the letter; the submission timeline is verified; the evidence checklist is resolved; any missing element blocks release.
05
Specialist release
A licensed nurse or PA reviewer reviews the exception queue and signs the release. High-dollar or complex cases route to physician review first.
06
Delivery
You receive the pack: the submission-ready justification, the evidence matrix, the payer policy checklist, the appeal package (if denied), and the tracking log — ready for the physician to review and submit.
The bar we hold
Rigor you can measure.
100%
Specialist-released
No pack ships without a licensed clinical reviewer signature.
5 days
Standard SLA
From complete intake to released pack.
<1%
Critical-defect target
Tracked against a gold-standard pack library.
4
Lien-search sources
DHSMV · USCG · UCC · judgment, every applicable file.
Why Specialty Prior Authorization Approval Engine
Built to be the most thorough option a practice has.
Documentation-complete, by design
The deliverable is completeness itself — every clinical criterion and payer policy element accounted for or explicitly exception-coded. Nothing is left implicit.
Deterministic, not vibes
The gates that decide completeness are code, not a model's opinion. A drafting error cannot slip past a policy requirement.
In its lane, on purpose
We prepare documentation and run searches as your clerical agent. We never make medical decisions, give clinical advice, or replace the physician's judgment.
Engagement
Flat fee, per released pack. No contingency, ever.
Simple, predictable, and aligned with a documentation standard — not a cut of any recovery.
- A free Delinquency Gap Scan before you commit — see exactly what is missing.
- One flat fee per released Prior Authorization Pack; disclosed pass-through search fees.
- Optional fixed-fee physician review for high-dollar or complex cases.
- Optional Appeal Continuity Add-on for the denial appeal package, pre-dated to the denial date.
FAQ
Questions, answered precisely.
Is Specialty Prior Authorization Approval Engine a law firm?
No. Specialty Prior Authorization Approval Engine, a service of Your Deputy, Obuke LLC, provides documentation-completeness services. It is not a law firm, does not provide legal advice, and does not represent you in any legal matter. Physician review is available and recommended for high-value or complex cases.
Do you contact the patient or collect the debt?
Never. Specialty Prior Authorization Approval Engine is not a debt collector and does not contact patients or debtors. The practice remains the provider and the party responsible for all patient communications.
What makes a pack 'complete'?
Completeness is defined by the payer's medical policy: every clinical criterion matched to chart evidence, the submission timeline verified, the evidence checklist resolved, and the appeal package ready. Deterministic gates enforce each one before release.
How fast is it?
The standard SLA is five business days from complete intake to a specialist-released pack. The free Gap Scan is returned much sooner and tells you exactly what is still needed.
How are you priced?
A flat fee per released pack, plus disclosed pass-through search costs. No contingency and no percentage of any recovered amount or sale proceeds.
See what's missing before it costs you a denial.
Start with a free Delinquency Gap Scan. Send your order and patient chart and we'll return a completeness read against every criterion of the payer's medical policy.
Documentation-completeness service · not medical advice · the practice submits every authorization.