Specialties
Payers ask an oncologist and an orthopedic surgeon for very different things. PriorPilot is configured per service line, so each request reflects what that payer actually reviews.
MRI, CT, PET, nuclear cardiology
What payers usually ask for
How PriorPilot handles it
Requirements are often decided by a radiology benefit manager rather than the health plan itself. PriorPilot identifies the delegated vendor for each plan and fills that vendor's criteria, not a generic form.
Chemotherapy, immunotherapy, supportive drugs, radiation
What payers usually ask for
How PriorPilot handles it
Requests are built per regimen rather than per drug, so a multi-drug cycle goes out together. Changes in cycle or dose trigger a check on whether the existing authorization still covers them.
Joint replacement, spine surgery, arthroscopy, DME
What payers usually ask for
How PriorPilot handles it
Surgical requests usually need evidence spread across months of visits. PriorPilot assembles that history in date order and highlights anything the payer's policy requires that the chart doesn't show yet.
Cardiac imaging, electrophysiology, devices
What payers usually ask for
How PriorPilot handles it
Test results are read from structured observations and reports, so values like ejection fraction come from the source document rather than retyped by staff.
Home sleep tests, in-lab studies, PAP therapy
What payers usually ask for
How PriorPilot handles it
PriorPilot checks whether the home test is the payer's required first step before an in-lab study is requested, which is one of the most common reasons for denial in this service line.
Biologics, injectables, pharmacy-benefit medications
What payers usually ask for
How PriorPilot handles it
Medical-benefit drugs go through the same queue as procedures. Pharmacy-benefit drugs use NCPDP ePA. Renewals are tracked so they're started before the current approval expires.
Tell us which services take your team the most time. We'll walk through how they'd run in PriorPilot.