PA Sherpa reads the payer's published policy, tells you exactly what documentation they require before you submit, and drafts the appeal if they deny anyway. Built and priced for independent specialty practices.
The demo runs on simulated data. No real patient information.
Sources: AMA Prior Authorization Physician Survey (2025), KFF Medicare Advantage Analysis (2024), CAQH Index (2024), MGMA Regulatory Burden Report (2026)
CMS's own data says the top reason denials get overturned is documentation that wasn't supplied at initial review. The medicine was right. The paperwork wasn't.
A knee replacement gets denied. Not because the knee wasn't bad enough, but because the note said "severe joint-space narrowing" instead of the three words the payer's policy required: "bone on bone." Same knee. Same evidence. Wrong words.
An illustrative composite: the kind of denial practices see every week.
PA Sherpa retrieves the payer's published medical policy and shows you the exact criteria, as a checklist cited to the policy itself, before you submit. So the note says what the reviewer is required to look for.
Prior authorization is the most hated process in healthcare. Insurance companies require pre-approval for procedures, and the burden falls entirely on medical practices.
Forty PAs per physician, every week, across phone holds, fax machines, and payer-specific portals. It's so much work that 40% of practices now have staff who do nothing else (AMA, 2025). A manual PA costs $12.88 and 24 minutes; electronic runs $5.38 and 10 (CAQH, 2024).
Patients call the office every 2 days asking "was my MRI approved?" Your front desk becomes a human status tracker. Meanwhile, 95% of physicians report PA delaying necessary care (AMA, 2025).
80.7% of appealed denials are overturned (KFF, 2024), yet only 21% of physicians always appeal, citing futility and staff time. That's procedure revenue left on the table, and it's a big reason 94% say PA drives burnout (AMA, 2025).
Everything your practice needs to submit, track, and win prior authorizations, grounded in the payers' own published medical policies, not generic AI.
PA Sherpa retrieves the payer's published medical policy for your procedure and turns it into a documentation checklist. Procedures, imaging, and services, not just drugs.
Enter patient and procedure info once. The AI scores approval likelihood and suggests clinical language that matches what the payer's criteria actually require.
The status page insurance never built. Give patients a simple link to check their PA anytime. No login, no phone calls to your office.
Denied anyway? One click drafts the appeal letter and a peer-to-peer prep brief, and every policy citation is verified against the source before you send it.
PA Sherpa replaces your Excel spreadsheet, your fax machine, and your "on hold with Aetna" playlist.
Patient info, diagnosis, and procedure. That's it. Our guided form handles the rest.
PA Sherpa checks the payer's published policy and builds your documentation checklist, with gaps flagged before anything is submitted.
One click to submit. Real-time status updates for your team and patients.
Denied? AI generates your appeal letter with clinical citations in under 30 seconds.
In Medicare Advantage alone, insurers made 52.8 million PA determinations in one year. Follow what happens to the denials:
The denials mostly don't survive scrutiny. The system works because fighting back costs staff time you don't have. 59% of physicians who skip appeals cite futility; 52% cite staffing. When the appeal takes one click instead of one afternoon, the math flips to your side.
Sources: KFF Medicare Advantage Analysis (2024), AMA Prior Authorization Physician Survey (2025), Arthritis Care & Research
The CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F) already mandates faster PA decision times as of January 2026, and requires payers to support standardized FHIR APIs for electronic PA submission by January 2027.
But read the fine print: the rule doesn't cover drugs or commercial plans. Most of your PA volume isn't waiting on Washington. That's the reason to fix your workflow now, not in 2027.
We're building on FHIR R4 and Da Vinci PAS standards now, so your practice is ready the moment payers are required to connect, and covered where the rule doesn't reach.
Every meaningful PA vendor sells to health systems and health plans: enterprise contracts, no published pricing, and drug-only scope that leaves your MRIs, injections, and procedures on their own. Among practices like yours, 90% say PA burden rose in just the last year, and 92% had to hire or redistribute staff to cope (MGMA, 2026). Nobody built for you. We did.
Enterprise PA tools cost $50K+ and take 6 months to implement. PA Sherpa is live in a day, with published pricing and self-serve onboarding at beta launch, because a 3-physician practice deserves a price tag it can see.
Our AI understands the clinical guidelines, CPT codes, and payer requirements specific to your specialty.
Cloud-based, works in any browser. No hardware, no EHR integration required to start. Just log in and submit your first PA.
Now onboarding Atlanta-area beta practices. Founding practices get free access, a direct line to the founder, and a real say in shaping the product.
Free for beta practices. No credit card required.