Prior Authorization and Peer-to-Peer Support Behind Your RCM Platform
Your AI extracts the request and routes it. The payer still wants a person to call for status, submit the clinicals, and put a clinician on a peer-to-peer. We are that team, under your brand. Dedicated, remote specialists from a HIPAA-compliant healthcare BPO, billed at a flat fee per specialist, not a percentage of collections. One BAA. Live in 2 weeks.
Your AI routes the request. We make the calls and peer-to-peers.
Prior auth specialists behind your platform, under your brand. One BAA.
What CMS-0057-F does not automate
Your platform extracts the request and routes it. The payer still wants a person to call for status, assemble and submit the clinicals, and put a clinician on a peer-to-peer review. CMS-0057-F sets faster timelines and an API, but it does not automate the clinical decision and it does not remove the peer-to-peer phone call. That work is what this pod owns, under your brand, written back into your platform.
Where automation stops and the prior auth pod starts
Dashboard values below are Staffingly internal benchmarks for 2026 and are directional, shown to illustrate the human-required tier. Cited statistics carry their source.
Prior auth turnaround
Days to a prior auth decision before vs after the pod. Internal benchmark, 2026 (directional).
Where the pod spends time
Prior auth work split across status calls, clinical submission, and peer-to-peer. Staffingly internal data, 2026, directional.
Staff hours per week
Staff hours per week on prior auth, in-house vs with the pod. Directional internal benchmark for 2026.
The prior authorization and peer-to-peer support your platform routes out
Prior auth stays largely manual
Prior authorization volume is high and stays largely manual. Staff spend many hours each week assembling and submitting requests (AMA).
CMS-0057-F does not automate the decision
The rule sets faster timelines and an API, but a person still assembles and submits the clinicals, and the clinical decision stays with the payer.
Peer-to-peer is clinician phone work
A peer-to-peer review puts a clinician on the phone with the payer medical director. No API removes that call.
Status and resubmission calls
Follow-up calls for status and resubmissions stay manual when the automated request stalls.
Dedicated, not shared. One flat rate.
A dedicated, remote FTE behind your platform, billed at a flat fee per specialist, not a percentage of collections. A HIPAA-compliant healthcare BPO deployed in 48 to 72 hours, scaling from a pilot to 100 or more. One BAA. Live in 2 weeks.
Questions? Call (800) 489-5877.
Explore the rest of the workforce
Each pod owns one human-required workflow behind your platform. Start with the hub or jump to another pod.
AI + Human RCM Hub
The full human-in-the-loop workforce that sits behind your platform across every pod.
Back to the hubAR Calling and Payer Follow-Up
Live reps chase claim status, work 30-60-90 buckets, and recover aged dollars under your brand.
Explore the podEligibility and Benefits Verification
270/271 failures, member-not-found, and coordination-of-benefits cases worked by a live rep.
Explore the podDenial Management and Appeals
Denial triage, appeal writing, and payer follow-up that recover overturned dollars.
Explore the podFrequently asked questions
Does CMS-0057-F eliminate prior authorization phone work?
No. CMS-0057-F sets faster timelines and a Prior Authorization API, but it does not automate the clinical decision and it does not remove peer-to-peer phone reviews. A person still assembles and submits the clinicals and calls for status.
Can peer-to-peer prior authorization reviews be automated?
No. A peer-to-peer review puts a clinician on the phone with the payer medical director. No API replaces that call.
Who submits the clinicals when the automated request stalls?
Our prior auth specialists assemble and submit the clinical documentation, call the payer for status, and schedule and staff peer-to-peer reviews, under your brand and written back into your platform.
Can I white-label a prior auth team behind my platform?
Yes. The prior auth pod works under your brand as your fallback workforce, with one BAA and a 2-Week Risk-Free Pilot.
Do you provide clinician staff for peer-to-peer reviews?
Yes. We provide clinician staff to take the peer-to-peer call with the payer medical director when a determination needs it.
Are your prior auth staff HIPAA compliant?
Yes. We operate under HIPAA-compliant workflows with SOC 2 Type II, HITRUST, and ISO 27001 alignment, signed BAAs, role-based access, and audit logging. Teams work from biometric-secured facilities.
How much does white-label prior authorization outsourcing cost?
A flat fee per dedicated specialist: $349 per week for 5 or more FTEs and $299 per week at 10 or more FTEs, not a percentage of collections. A fully loaded in-house hire often runs around $5,000 or more per month.
How do your specialists work inside our platform and payer portals?
They work through your own access controls, with role-based permissions, multi-factor login, and audit logging, under a signed BAA. The pod operates inside your platform and the payer portals as an extension of your exception queue, not a detached BPO, and every outcome is written back into your system.
Written By
Dan Nandan is the President and CEO of Staffingly, Inc. With 25+ years in IT consulting and healthcare BPO operations, he was one of the earliest US operators to set up an RPO/BPO delivery network in India over 20 years ago. Today his work centers on the human-in-the-loop workforce that sits behind AI and automation RCM platforms across North America, helping practices and platforms cut administrative cost without compromising care.
