Prior authorization

Three ways auth write-offs happen

And how we can solve each one.

Why these never come back. About 85% of payers allow no retro authorization, and the rest give you a few days. A contractual denial cannot be billed to the patient. Everything has to happen before the claim goes out.

The fixes below are done by an AI we built. It signs into the same payer and UM portals your team uses, like a new employee would, and does this work itself. No integration project, no API build.

Scenario 1

The portal said no auth was needed

Your team checks the portal. It says none required.
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The case goes ahead. Nothing is written down.
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Months later the claim denies for that exact auth (CARC 197).
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Write-offNo retro auth, and the patient cannot be billed.
How we solve itThe AI checks whether the plan requires an auth before every single case, reading the plan's own current policy the way your team would. When one is needed, it builds and submits the request itself, straight from the chart, and saves the answer with the case.
The return
50,000 auths a year, manual at $12.88$644K
The same auths, electronic at $5.38$269K
Saving you $375K a year
on handling alone. The calculator below runs your volume.
Scenario 2

The request went to the payer, not the utilization management company

The request goes to the payer on the card.
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But a utilization management company, EviCore, Carelon, TurningPoint or Magellan, actually reviews that service.
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It sits in the wrong queue until the date of service arrives.
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Write-offThe service happened without an approved auth.
How we solve itThe AI works out which utilization management company reviews that service for that plan and files the request there directly, in whichever portal that is. It tracks the request to a determination, and flags your team if they need more.
The return
3x the working hours
the queue is worked 24 hours a day instead of one shift.
Scenario 3

The auth was approved but did not match the claim

The auth is approved and sitting on file.
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The claim bills different codes, dates, units or site.
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Denied anyway. An approval is not a guarantee of payment.
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Write-offOr rework, weeks later, if someone catches it.
How we solve itBefore the claim goes out, the AI reads the approval letter for the exact codes, dates and units that were approved, and checks the claim against it. Mismatches get fixed before the payer ever sees them.
The return
Minutes, not weeks
fixed before submission, not fought after a denial.
15 to 25
auths a person typically gets through in a day
60%
of prior auths are still handled manually
58% cheaper
per auth, moving from manual to electronic handling: $12.88 down to $5.38 on CAQH's own numbers, $7.50 back on every auth

What this looks like in practice

$1.4M

One Florida cardiology service line was writing off $1.4 million a year to prior auth, across just three payers and one physician. That is where we started with them: our AI running auth for those three payers, extending into eligibility and denials next.

What it is worth to you

Three numbers of yours. Rough is fine; the math only uses what you enter.

CARC 197, last six months, divided by six
From the same report
Surgery, imaging, infusion, therapy
Leaking todaywritten off a year, not recoverable
$1.6M
Denials preventedif a third of those write-offs never happen
$540K
Handling, manual to electronicyour auth volume at CAQH's $7.50 gap
$375K
Back on your books, every year
$915K
A+ from KLAS, June 2026Becker's 2026 Top RCM CompaniesHeadspace · SonderMind · Ideal Eye SurgeryNo code list. No payer network to join.

Worth twenty minutes?

Bring your last six months of CARC 197 denials and we will walk back which of the three leaks is costing you the most, and what closing it takes. If your workflow is already tight, we will say so.

Reply with a day that works and we will set it up.

Retro authorization availability, UM vendor routing, the approval-does-not-guarantee-payment rule, round-the-clock operation, and the 15 to 25 auths per person per day figure are from Magical's RCM workflow reference. Manual and electronic per-auth costs are the 2024 CAQH Index; the 58% reduction and the $644K, $269K, $7.50 and $375K figures all derive from those two published costs, with dollar totals at an assumed 50,000 auths a year; they are an industry benchmark rather than a Magical price. The share of authorizations still handled manually is CAQH. CARC 197 is the X12 code for authorization absent. The cardiology figure is the write-off exposure at a current Magical engagement, unnamed at the customer's discretion; it is the size of the problem we were brought in on, not a result to date. KLAS A+ likelihood to recommend, June 2026. Customer names shown are published case studies. The "third prevented" line is an illustration, not a guarantee; the calculator uses only the numbers you enter.