Prior authorization for hospitals
Ruvo owns the prior auth. Hold music included.
An agent that takes each prior authorization from your work queue to a decision. It checks coverage and submits to the payer. When the portal says pending, it picks up the phone: IVR, hold, rep, reference number, written back to your worklist. Calls that need a person go to your people, live.
- 09:02Dialed provider services. Outpatient MRI, date of service in five days. Member ••••
- 09:03IVR: pressed 3 for authorization status. Entered NPI and member ID by keypad.
- 09:04On hold. 21 min
- 09:25Rep:
Thanks for holding, this is Denise.
- 09:25Ruvo:
Hi Denise. This is Ruvo, an automated assistant calling on behalf of ••••••• Medical Center. This call is recorded. I'm checking an authorization submitted Tuesday for an outpatient MRI, member ending ••••. The portal still shows pending.
- 09:27Rep:
I show that approved as of yesterday. Reference number is...
- 09:27Ruvo:
Reading that back: Ref ••••. Thank you, Denise. I'm noting your name and the time on the case.
- 09:28Approved. Written to the worklist, case closed. Authorization number on the encounter so the claim carries it.
Prior authorization is a phone job dressed up as software.
- 40%of medical prior auth is fully electronic1
- 13 hrsa week per physician, with staff, on prior auth2
The other 60% ends in a portal that says pending or a provider services line with a hold queue. Hospitals staff that queue with people who could be doing anything else. The AMA asked 1,000 physicians in late 2024: 39 prior authorizations per physician per week, 13 hours of physician and staff time, and at 40% of practices someone does nothing else.
Most automation covers the 40% and hands the rest back to your staff. The call vendors make the call and hand back the data. Either way the case has no owner. Somebody at your hospital still has to pick it back up.
We built for the 60%. Ruvo owns the case. The phone call is part of the job, not the product.
What Ruvo does with a case
- Takes it from your work queue.A scheduled service that needs an authorization, with a date of service attached.
- Runs the 270/271.Coverage active, benefits read. Then checks whether this payer requires an authorization for this service.
- Submits where the payer takes a submission.Portal or 278. Checks back on a schedule, not when somebody remembers.
- Picks up the phone when the portal says pending.Navigates the IVR, waits out the hold, talks to the representative, reads the reference number back, gets the rep's name.
- Closes the case in your worklist.Approved with a reference. Denied with the reason. Pended with a next action date. Or open under a named person on your team. Nothing comes back as a data drop to re-key.
- Transfers the calls that need a person.Live, with the call history attached. That includes the payer that won't deal with a third party, and the peer-to-peer request your specialist schedules with the ordering physician.
- ApprovedMRI lumbar, outpatient. Reference and rep name on the case. Authorization number on the encounter.
- DeniedCardiac PET. Payer's reason on the case: criteria not met for the requested code. Appeal drafted for your release.
- PendedKnee arthroscopy. Payer requested office notes. Sent. Next action date set; the agent calls again if the portal is still quiet.
- OpenCardiac cath. Peer-to-peer requested. Under Dana on your team, with the call history attached.
Your clinicians get the conversations. Not the phone tree.
The conversations that need a clinician still get one. What they don't get anymore is the hold before the conversation, or the portal check at 7 a.m. to see if anything moved. Ruvo does the waiting and brings a person in at the moment a person matters, with everything the payer has said so far in front of them.
A case pended within 72 hours of the date of service, or older than seven days, also goes to a person. Pending is not a disposition.
Goes to a person when
- The payer asks for a peer-to-peer with the ordering physician
- The representative raises a clinical question
- The payer won't deal with a third party on the line
- The case is pended within 72 hours of the date of service, or older than seven days
Live transfer while the payer is on the line. Otherwise back in your queue with a reason code, the same business day.
- 10:41Cardiac catheterization, date of service in six days. Portal pended since Monday. Called provider services.
- 10:58Rep:
The medical director is requesting a peer-to-peer with the ordering physician.
- 10:58Ruvo:
Understood. I'm bringing Dana from the hospital's clearance team on now to set that up with the ordering physician.
- 10:59Transferred live. Call history attached. Case stays open in the worklist under Dana. Reason code: peer-to-peer requested.
Where this goes
We started with the authorization because it is the most human-shaped work in the revenue cycle, and the hardest payer call in the building. The others are easier.
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Running today October 2026
Eligibility and prior authorization, phone calls included. Results in your worklist. Exceptions to your people.
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Next
The other payer calls: admission notification, claim status, denial reason, appeal status.
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Then
The claim itself, then the payment. Each step gets a date when it is in a pilot, not before.
What we expect to move, and will measure with you
The numbers sit in patient access and in the denials that start there. Each pilot agrees them before the first case.
What we won't claim: days in A/R, cost to collect, net collection rate. Those depend on claim and payment work we don't run yet. When we do, we'll claim them.
- Scheduled cases without an authorization at 48 hours out
- Day-of cancellations for a missing authorization
- Authorization-related initial denials, and the write-offs behind them
- Hold minutes per FTE
- Cost per authorization
- Overtime and contract labor in patient access
The terms, before you ask for them
$25 per completed authorization. Flat. If one we closed denies as not on file, you don't pay for it.
Completed means decided: approved, or denied with the payer's reason on the case. Pended doesn't bill. No seats. No implementation fee.
We would rather eat a fee than argue about attribution.
How a pilot runs
- ScopeOne authorization-heavy service line: advanced imaging, cardiology, outpatient surgery, or hospital-based infusion.
- LengthThirty days of baseline on your current numbers, then ninety days live on the same cases.
- Agreed firstAuthorizations decided before the date of service. Authorization-related denial rate against the same period last year. Staff minutes per authorization. A defect rate from sampled call recordings checked against the portal.
- PriceFlat fee per completed authorization. Credited when a closed authorization later denies as not on file; we work the appeal.
Questions you'll have
Who holds the PHI?
Ruvo signs a BAA before anything moves. Call recordings and transcripts are stored in the US, kept for a year, and yours on request. SOC 2 Type 2 is scheduled; until the report lands, you get our security questionnaire answers, policies and penetration test results.
Does it write into Epic?
During a pilot, cases come to Ruvo as a daily work queue export from Epic or Oracle Health over SFTP, and results go back into the authorization record, with the number, the reference and the rep's name, through the access you grant. After the pilot, an interface. Either way there is no second worklist to watch.
What if the rep was wrong?
Every call is recorded and transcribed, with the reference number and the rep's name on the record. The phone result is reconciled against the portal or the 278 response. If a claim still denies as not on file, see the terms: we work the appeal and you don't pay for that authorization.
Who is on the call?
Ruvo, calling as your authorization desk. When the agent is the one on the line, it says so. When a case needs a person, a person is on the line. If a payer won't deal with a third party at all, your specialist gets the call live and the case is marked so the next one starts with your staff.
Who signs clinical appeals?
Your staff. Ruvo drafts, a person releases. Nothing clinical goes to a payer under your name without a signature from your side.
Who is this for?
Community hospitals and regional systems, 150 to 500 beds, with a clearance unit that is small and payers that are not. Imaging, cardiology, outpatient surgery, infusion. Epic or Oracle Health, with a clearinghouse already covering the electronic share. If you want a dashboard your staff still has to work, we're not it.
If your people spend their mornings on hold
Write to us. We'll show you a call on your payer mix and scope a pilot on one service line.
1. CAQH Index, 2025: medical prior authorization electronic adoption rose from 31% in the 2023 Index to 40% in the 2025 Index. AJMC summary.
2. AMA survey of 1,000 physicians, late 2024: 39 prior authorization requests per physician per week; 13 hours of physician and staff time per week; 40% of physicians have staff who work exclusively on prior authorizations. AMA.