Daily scan breakdown
| Category | Scans | Patients | % of day |
|---|---|---|---|
| Wednesday 5/14 — 56 scans · 37 patients | |||
| WC | 21 | 9 | |
| Cash | 1 | 1 | |
| Insurance | 34 | 27 | |
| 5/14 Total | 56 | 37 | |
| Thursday 5/15 — 42 scans · 32 patients | |||
| WC | 6 | 3 | |
| Cash | 8 | 6 | |
| Insurance | 28 | 23 | |
| 5/15 Total | 42 | 32 | |
| Friday 5/16 — 4 scans · 3 patients | |||
| WC | 3 | 2 | |
| Cash | 0 | 0 | |
| Insurance | 1 | 1 | |
| 5/16 Total | 4 | 3 | |
| Saturday 5/17 — 7 scans · 3 patients | |||
| WC | 5 | 2 | |
| Cash | 0 | 0 | |
| Insurance | 2 | 1 | |
| 5/17 Total | 7 | 3 | |
| Week Total | 109 | 75 | |
Patient count is a sum of daily unique patients.
Category totals — week
| Category | Scans | Patients | % of scans |
|---|---|---|---|
| WC | 35 | 16 | 32% |
| Cash | 9 | 7 | 8% |
| Insurance | 65 | 52 | 60% |
| Total | 109 | 75 | 100% |
Authorization activity
Target: approval confirmed 48 hours before appointment. All delays and denials were attributed to third-party factors.
Wednesday 5/14
12 auths
10 Insurance
2 WC
Approved in time
9
Delayed — external
3
On time
75%
2 — Provider did not supply required clinical information
1 — Last-minute scheduling; insufficient info to obtain approval in time
Thursday 5/15
12 auths
12 Insurance
Approved in time
6
Denied — payer
1
Delayed — external
5
On time
50%
1 — Payer denial: MRI performed too recently per plan policy (accurate determination)
3 — Missing clinical documentation from ordering provider
2 — Last-minute scheduling
Friday 5/16
2 auths
1 Insurance
1 WC
Approved in time
1
Delayed — external
1
On time
50%
1 — HMO plan; ordering provider had not processed auth. Contacted and requested submission.
Saturday 5/17
1 auth
1 WC
Approved in time
1
Delayed — external
0
On time
100%
Authorization week summary
Total auths
27
across 4 days
Approved in time
17
63% on-time rate
Delayed — third parties
9
+ 1 payer denial
External delay & denial reasons — week
5 — Provider did not supply required clinical information
3 — Last-minute scheduling by ordering provider
1 — Payer denial: MRI performed too recently per plan policy (accurate determination)
Learnings & next steps
1
Last-minute scheduling is a common use case
A meaningful portion of appointments are scheduled with limited lead time. In these cases, we are focused on expediting submissions so that eligibility is verified and a PA determination is at least initiated — ensuring authorizations are in-flight or pending by the time the patient is seen.
2
Clinical documentation gaps — workflow in development
Missing clinical documentation from ordering providers has been the leading cause of authorization delays this week. We are actively building a standardized outreach workflow to proactively request required documentation as soon as an authorization is initiated, reducing turnaround friction.
3
CMS eligibility checks pending enrollment completion
Patient eligibility verification through CMS is not yet available until the enrollment process is finalized. Once completed, this will unlock real-time eligibility checks and reduce upstream uncertainty in the authorization workflow.
4
Patient OOP estimates & good faith estimates — pending
Delivery of patient out-of-pocket cost estimates and good faith estimates is ready to be enabled, but requires accounting to complete the bank account setup first. Once that step is finalized, this feature can be activated — giving patients cost transparency upfront and keeping the practice in compliance with No Surprises Act requirements.