General information, not legal or medical advice — always confirm specifics with the payer or your compliance counsel.
Prior authorization automation is software that drafts the request letter a payer requires before approving a procedure, medication, or service — pulling from chart notes and matching the payer's own published medical necessity criteria. Asaanbil drafts the letter in minutes; a physician still reviews and approves it before it's submitted.
Staff enter the case — diagnosis, exam findings, conservative treatment already tried — in a short intake form. Asaanbil matches those details against the specific payer's published criteria and drafts a structured letter citing the exact clause, flagging any missing documentation before submission rather than after a denial.
Aetna denials are appealed by citing the specific Clinical Policy Bulletin (CPB) the reviewer used and showing exactly how the documentation meets it, within Aetna's stated appeal window on the denial letter. Asaanbil generates the appeal directly from the denial, citing the matching CPB automatically instead of your staff hunting for it.
UnitedHealthcare's clinical reviews largely follow InterQual, but since that's proprietary, appeals are strongest when they cite the ACR Appropriateness Criteria UHC's own reviewers accept as an equivalent standard. Submit within the deadline printed on the denial notice, and request a peer-to-peer review if the first appeal is denied.
Cigna delegates most imaging and specialty PA to eviCore, so the appeal needs to cite eviCore's own published clinical guideline, not a generic Cigna policy. eviCore denials typically list the specific guideline number on the denial letter — the appeal should quote it directly and show where the chart note satisfies it.
Humana Medicare Advantage denials are appealed against CMS coverage rules, since Medicare Advantage plans can't be more restrictive than Traditional Medicare on covered services. Commercial Humana plans use the proprietary MCG system instead, so those appeals cite ACR Appropriateness Criteria as the closest public equivalent.
A standard Medicare Advantage appeal (reconsideration) generally must be filed within 60 days of the denial notice, though the exact window is always printed on the notice itself and should be confirmed there. Expedited appeals for urgent cases have a much shorter turnaround and a specific request process.
According to a KFF analysis of CMS data, 80.7% of Medicare Advantage prior authorization denials that are appealed get overturned — but only about 11.5% of denials are ever appealed at all. The gap isn't about the merits of the case; it's almost always that no one had time to file before the deadline passed.
Most PA denials come down to missing or incomplete documentation against the payer's specific criteria — a conservative-treatment history that wasn't clearly noted, a required exam finding that wasn't included, or a code mismatch — rather than the case itself lacking medical necessity. Citing the exact payer clause up front is what prevents most of these.
Medical necessity criteria are the specific, published clinical standards a payer's reviewer checks a request against before approving it — things like required conservative treatment duration, imaging findings, or diagnostic codes. Each payer (Aetna's CPBs, eviCore's guidelines, CMS's NCDs/LCDs) publishes its own, and they don't match each other exactly.
Yes — a patient can file their own appeal, and some payers require the patient (not just the provider) to be the one who submits it for certain plan types. Asaanbil lets a patient generate a structured, criteria-cited appeal from their own dashboard, with the ordering physician's statement attached as supporting documentation.
An AI front desk is software that handles the administrative work a human receptionist and coordinator would otherwise do — answering calls, booking appointments, drafting prior authorizations and appeals, and coordinating staff tasks — from one dashboard instead of several disconnected tools. It's meant to run alongside existing staff, not replace clinical judgment.
Yes — asaanbil.com's AI receptionist answers inbound calls around the clock, handles routine questions, and books appointments directly into the practice's real schedule. Calls it can't resolve are routed to staff instead of dropped.
Patients book through a conversational flow — by phone with the AI receptionist or online on the practice's public profile — against the practice's actual open slots, with a telehealth room created automatically when the visit type calls for one. No account creation is required to book.
Asaanbil is built HIPAA-ready: every action on a PA request, letter, patient record, or claim denial is logged with user, action, and timestamp, and each practice's data is isolated at the database layer. A Business Associate Agreement is required and enforced at onboarding — we don't claim certifications (like SOC 2) that we don't actually hold.
No — asaanbil.com runs alongside your existing EHR rather than replacing it. Staff keep working the same way; they just stop starting every PA letter and appeal from a blank page.
Pricing is broken into separate doctor and patient plans, billed monthly or annually — see the Pricing section on this page for current plan details. There's also a free pilot for practices trying it for the first time.
Yes — asaanbil.com offers a free pilot so a practice can see real letters drafted against its own cases before committing to a paid plan. No EHR migration or IT project is needed to start.
A prior authorization is the request submitted before a service is performed, asking the payer to approve coverage in advance. An appeal is what's filed after that request (or a later claim) is denied, arguing — usually with the same or additional clinical documentation — that the denial should be reversed.
Payer turnaround for a standard PA decision typically runs anywhere from a few days to two weeks depending on the payer and service, with expedited review available for urgent cases. Drafting the request itself is usually the slow part on the practice's side — a letter written from scratch takes 30–45 minutes; asaanbil.com drafts one in under 10.
At minimum: the diagnosis (ICD-10), the requested procedure or service (CPT/HCPCS), relevant exam findings, and documentation of any conservative treatment already tried. Exactly which fields are required varies by payer and procedure — asaanbil.com flags anything missing before the letter is drafted.
Yes — tasks can be assigned to a specific staff member with a due date, marked as team-wide or personal, and tracked through to completion. It replaces the sticky-note-and-Slack-message approach most small practices default to.
Patients control their own record and explicitly grant access to a practice; once granted, the doctor sees the patient's details and medical history directly in the platform, with no faxing or phone calls required. The patient can revoke that access at any time.
Yes — booking through a doctor's public profile doesn't require creating an account first. Creating a free patient account adds ongoing benefits, like managing appointments and generating a PA appeal directly, but isn't required just to book a single visit.
Yes — when a booked appointment type calls for a video visit, a telehealth room is created automatically as part of the booking, with no separate video-conferencing tool to set up.
Asaanbil's public doctor directory is searchable by specialty, insurance accepted, language, and availability, so a patient can filter down to doctors who actually take their plan before booking.
A peer-to-peer review is a phone conversation between the ordering physician and the payer's medical reviewer, usually requested after an initial denial, where the physician can explain the clinical reasoning directly instead of relying only on the written letter. It's often faster than a formal written appeal and can be requested alongside one.
Missing the appeal window generally means losing the right to challenge that specific denial through the standard appeals process, though some payers and plan types allow a good-cause exception in limited circumstances. This is the single biggest reason practices lose winnable appeals — the case was strong, but nobody filed in time.
Asaanbil is built specifically for solo-to-small-group practices (1–10 physicians) that can't justify hiring a dedicated PA coordinator or scheduling specialist — it's priced as a monthly platform subscription, not an enterprise software contract, with a free pilot to try it first.
A virtual assistant service sells you a person's time to do these tasks manually, at an hourly or per-task cost that scales with volume. Asaanbil is software your existing staff uses directly — it drafts letters and handles calls automatically, with a human still reviewing and approving everything, at a flat platform cost that doesn't scale per letter.