Prior authorization & records
Prior authorization that runs itself to resolution
Auth work is deadline-driven, payer-specific, and unforgiving of gaps in follow-up. Perivanta works out what each case requires, assembles the evidence, submits it, chases it to an answer — and re-verifies the approval when the case changes underneath it.
Perivanta is in development with founding design partners — this page describes the capability we’re building together.
- Follow-up ran on the payer’s clock — not a sticky note’s
- The CPT change triggered exactly the re-check it required
“Approved” is not the same as “safe”
Prior auth is where cases stall. Requirements differ by payer, plan, procedure, and site of service, and discovering them is its own research project. Clinical records have to be begged from physician offices, submissions live in a different portal per payer, and follow-up survives on sticky notes and memory. When it slips, the case either cancels days before surgery or proceeds on hope.
The quieter failure is the approval that stops matching the case. The procedure gets refined at the clinic visit, the date moves, the site changes — and the auth that was fine in week one silently becomes a denial that surfaces weeks after the procedure, when the money is already at risk.
What Perivanta does with an authorization
Perivanta treats each auth as work it owns from requirement discovery to a verified, still-valid approval — not a status field somebody should remember to check.
Requirement discovery
Determines what this specific case requires from its actual facts — payer, plan, procedure, diagnosis, laterality, site — instead of a universal checklist.
Clinical evidence assembly
Requests, collects, and classifies the records the payer will ask for — H&P, imaging, conservative-care history — and assembles them in the payer's expected shape.
Submission on the payer's channel
Files through the channel each payer actually supports — API where one exists, portal or fax where it doesn't — and preserves the submission evidence.
Follow-through and escalation
Checks status on a schedule, chases silence, tracks promised-by dates, and escalates to your team when a payer stalls past policy.
Auth-to-case reconciliation
When the CPT, date, site, or payer changes, the approval is re-verified against the new facts — no stale auth quietly riding along to denial.
Peer-to-peer and denial prep
When a payer pushes back, packages the clinical evidence and history for the physician conversation or appeal — prepared, scheduled, and routed to the right person.
Attestations stay with your people
Payer attestations, clinical statements, and anything that speaks in a clinician's voice remain with authorized people — Perivanta prepares the work and carries it, but it does not make clinical judgments or sign on anyone's behalf.
Every submission, status check, and re-verification is logged with its evidence, so when a payer disputes the record, your center has one — timestamped, source-linked, and complete.
Common questions
- Which payers and channels does this work with?
- Perivanta uses whatever channel each payer supports: electronic authorization APIs where available, payer portals and fax where they aren't, and phone follow-up routed to your team as a prepared task when automation isn't possible. The case record is the same regardless of channel.
- What happens when the procedure changes after approval?
- The change triggers exactly the re-verification it requires. Perivanta compares the approval against the updated CPT, site, and date, determines whether the auth still covers the case, and either confirms it or starts the amendment with the evidence already assembled.
- Does Perivanta make clinical determinations?
- No. It collects and evaluates administrative evidence and enforces documented requirements. Questions that require clinical judgment — medical necessity arguments, peer-to-peer conversations — are prepared by the system and handled by your clinicians.
- How do escalations reach our team?
- As prioritized exceptions with the evidence attached: what the system was doing, why it stopped, what the payer said, and what it recommends. Your team resolves the judgment call; the system takes the case back from there.
Design partner program
Help build the system that does the work
We are selecting a small group of founding centers to shape the platform. Design partners get early access, direct input on the roadmap, and founding-partner terms.