PriorPilot
An AI prior-authorization and denial-management platform that auto-assembles and submits auths, predicts denials before submission, and drafts the appeals to recover revenue.
// The Authorization Queue — first-pass approval, turnaround, and denial exposure above a worst-first table of prior-auth requests.
Overview
PriorPilot turns a slow fax-and-phone prior-authorization process into a single triaged queue for a clinic revenue-cycle team. It reads the order and chart to auto-assemble a payer-ready submission packet, scores each request's denial risk 0–100 before it's sent, tracks status across every payer, and — when a decision goes the wrong way — drafts a citation-backed appeal with re-coding suggestions. BuildspaceLabs designed and built the MVP front end — an Authorization Queue for portfolio triage and a per-authorization detail view for working a denial and its appeal — turning a denial-prediction model and a stream of payer signals into a workflow a biller can act on in minutes.
Highlights
- Predicts likely denials before an auth is ever submitted
- Auto-assembles payer-ready packets from the order and chart, no manual collation
- Drafts citation-backed appeals so denied revenue gets recovered on time
- Every denial-risk score is explainable — weighted gaps, not a black-box number
Gallery
Outcomes
- Delivered a production-quality MVP of the Authorization Queue and authorization detail view in a 9-week engagement
- Consolidated intake, submission, denial prediction, and appeals into a single revenue-cycle workflow
- Gave RCM leadership a real-time view of first-pass approval and denial exposure across 214 auths in flight
- Established a reusable design system (status pills, denial-risk bars, appeal cards) for the product's next surfaces
Tech Stack
Chosen per constraint, not per habit — the stack shifts with the problem.
Features
- Authorization Queue with first-pass approval, turnaround, and denial-exposure KPIs over a status-coded requests table
- 0–100 denial-risk score computed before submission, attributed to specific fixable gaps
- Auto-assembled submission packets — order, chart notes, imaging, and codes matched to each payer's policy
- AI-drafted appeals with policy citations, re-coding suggestions, and a peer-to-peer path
- Live payer tracking across submitted, in-review, info-requested, and decided statuses
- Denial-reason and per-payer approval and turnaround analytics to fix recurring gaps at the source
See PriorPilot as its own site.
Beyond the build, we designed and shipped PriorPilot a standalone landing page — its own look, copy and motion. Here's a live preview; scroll inside it, or open it full-screen.
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