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Prior Auth ROI Calculator
See your annual denial rework cost and estimated ROI for an AI-assisted UM workflow. Numbers update live. No email required to use the calculator.
Your numbers
120 / week
Include all service types
22%
Initial + first-level appeal combined
$12K
Surgical cases raise this significantly
4 hrs
Includes coordinator + physician peer-to-peer time
$28/hr
UM coordinator + physician time weighted
Current state · Annual cost
Annual PA Volume
6,240
Total PA requests per year
Annual Denials
1,373
At 22% denial rate
Rework Staff Cost
$154K
Coordinator + physician time on denied cases
Lost Revenue Estimate
$2.5M
~15% of denials never successfully resubmitted
Total Annual Cost of Current Process
$2.6M
Rework cost + unrecovered revenue
With AI-assisted workflow · Projected
Projected Annual Savings
$1.7M
55% rework reduction + 40% fewer final denials
Estimated Months to ROI
1
Based on Year 1 license + royalty estimate
Assumptions
AI-assisted scenario assumes: 55% rework hour reduction through documentation completeness scoring; 40% fewer final denials through pre-submission criteria matching; 15% → 8% rate of unrecovered denied claims. Year 1 cost estimate is approximate — actual depends on patient volume and feature scope.
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