For Independent durable and home medical equipment suppliers, including CPAP and respiratory resupply, oxygen, and mobility
Track DME prior authorizations and recertifications before they lapse
Many rentals and Medicaid items carry a prior authorization with an end date, and oxygen and some other items need a new order or recertification on a schedule. The dates are scattered across payer portals and your billing system, and the first sign of a lapse is a denial for a month already delivered.
What it can cost you
Example: 10 lapsed authorizations a quarter x 1 month of denied rental at $150 = $1,500 a quarter, plus the rework.An illustration, not a promise. Your Opportunity Scan puts a real number on it.
What the system checks overnight
- Lists prior authorizations ending within your set lead time, by payer.
- Flags rentals continuing past their authorization end date.
- Flags items that need a new order or recertification by its due date.
- Tracks pending prior auth requests by days waiting.
- Compares each payer's lead time with the date the renewal was actually started.
Where it reads from
- Brightree
- NikoHealth
- Bonafide
- Computers Unlimited TIMS
- Published payer prior authorization lists (outside data)
Published payer prior authorization lists for the items you bill, checked for changes.
What happens when it fires
Your authorization team gets a ranked list with what each payer needs. The system drafts the renewal checklist; a person submits.
Autonomy level: Draft for approval. The system prepares the message or task, and you approve it before anything goes out.
What we guarantee
Every prior authorization and recertification date is checked nightly and flagged within your set lead time. We agree on the metric before the Sprint starts and measure it over the first 20 business days after go-live. If we miss it, you get half your Sprint fee back. Dollar savings are tracked in your monthly saves log, reported rather than promised.
Questions
Do payers' prior auth lists change?
Yes, and the system can watch the payer lists you choose for changes to the items you bill. It flags changes for your team to review; it does not interpret coverage rules for you.
Will it submit prior auths?
No. It drafts the checklist and tracks status. Submission stays with your team.
Do I need new software for this?
No. The system reads from the tools you already use, with read-only access by default. A guardrail layer controls exactly which data the AI can see.
What does it cost?
A 3-week Sprint is $6,000 fixed and includes the morning brief plus one automation tied to an agreed metric. Ongoing support is $1,500 a month, or $500 a month to keep it running without new automations. If the agreed metric is missed over the first 20 business days after go-live, half the Sprint fee is refunded.
How is this different from a dashboard app or a free AI kit?
A dashboard app shows numbers when you go look. A free AI kit gives you the parts, and you do the setup, the upkeep, and the checking. Here the alarms are built for your kind of business, they watch outside data like market rates and rule changes alongside yours, and on Run or Keep-Running, the person who built them keeps them working and logs what they caught.
More alarms for DME and HME suppliers
Seven more things worth watching.
- Orders on hold for missing paperworkAge every DME order on hold by reason, flag missing signed orders and delivery tickets, and see which referral sources send incomplete paperwork.
- Denial patterns by payer and reasonGroup DME denials by payer, HCPCS code, and reason every night, and match new patterns to published policy updates before they repeat across claims.
- Resupply outreach stallingTrack CPAP resupply outreach by status, catch patients stuck after one failed contact, and flag shipments missing a documented patient request.
- CPAP adherence windows closingSee which new CPAP setups have no usage data or are trending short of the payer's adherence requirement while there is still time to help.
- Rentals out of sync with the fieldMatch pickup tickets against active rentals, flag capped rentals reaching ownership transfer, and catch serial number swaps billing on the old item.
- Orders stuck between referral and deliveryAge open DME orders by stage, from intake to verification, prior auth, and delivery, and flag orders waiting on back-ordered items.
- Item costs creeping past what payers allowCompare vendor cost per item with the allowed amount by payer and HCPCS code, and flag items that started losing money after a price or fee change.
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