For billing and authorization staff
Know what the payer needsbefore you send the request.
Find the patient's coverage criteria, fix missing information, prepare the request, and follow the case without rebuilding the work in separate systems.
Teams often learn what the payer wanted after the request is denied.A clearer worklist and fewer avoidable surprises.
The scenario
The denial that never happens
Today
- Day 1The request goes out with the notes you have. Nothing tells you what this payer requires for SBRT.
- Day 9Denied: documentation of oligometastatic disease not provided.
- Day 10You ask the physician for an addendum and rebuild the packet by hand.
- Day 24Approved on appeal. Three weeks of work for a case that met the criteria from the start.
With Just Healthcare
- Day 1, intakeThe payer's SBRT criteria are on screen next to the case, with the one that is not yet documented flagged.
- Day 1, reviewYou see exactly what to add. The medical-necessity rationale is prepared and sent to the chart for review.
- Day 1, submitThe request goes out complete, and the status is tracked automatically.
- Day 4Approved on first submission. The case moves forward on the worklist.
How the suite supports the work
One patient story, prepared for each step.
The suiteYour team
- 01
Start with coverage
Use Prisym™ to find the policy and patient-specific criteria.
- 02
Prepare the request
Use Submission Co-Pilot™ to find gaps and build the rationale.
- 03
Support the clinician
Use P2P Co-Pilot™ if the payer asks for physician review.
- 04
Respond to a denial
Use Responder™ to prepare a patient- and payer-specific appeal.
- 05
Keep the case moving
Track what is done, what is next, and who owns the follow-up.
What changes in the workday
- 01
Know the criteria
Find the applicable payer policy and see what must be documented, at intake instead of after a denial.
- 02
Close the gaps
Flag missing details and prepare the medical-necessity rationale before submission. Prepared letters go to the chart for review.
- 03
Connected to your systems
Eligibility, submission, and status move between the EHR, payer portals, and the products without re-entry.
- 04
Keep the case moving
One worklist for every case in flight: what is done, what is next, and who owns the follow-up.
Built on Just Healthcare Intelligence
Useful answers are not enough.Your team needs to see why.
Explore the platform- 01See the reasoningReview the criteria, patient facts, and sources used to prepare the work.
- 02Protect patient informationSecurity, access controls, and audit trails are built into the workflow.
- 03Keep people in controlYour team reviews the work and decides what happens next.
Start with the problem that hurts most
Show us where your team is losing time.
We will show you which product fits the work, what your team would see, and how the solution can support the way your organization operates today.