Can Sarva handle peer-to-peer reviews?

Peer-to-peer reviews require physician involvement and cannot be fully automated. Sarva schedules the review, prepares the physician with relevant clinical documentation and talking points, and tracks the outcome — but the physician must participate in the call.

What happens if a PA is denied?

Sarva escalates denials to staff with the denial reason, relevant clinical documentation, and recommended next steps (appeal, peer-to-peer, or alternative service). Staff handle the exception with all necessary context provided automatically.

Does this work for all payers?

Sarva works with all major commercial payers and Medicare Advantage plans. Some smaller payers and certain Medicaid plans may require manual portal submission. Sarva identifies these and routes them to staff with all documentation pre-assembled.

Use Case

Prior Authorization Automation for Healthcare Practices

Prior authorization automation uses AI to identify services requiring authorization, auto-generate submission packages with clinical documentation and supporting codes, submit to payers, and track approval status in real time. Sarva maintains a continuously updated library of payer-specific PA requirements so your team sees exceptions — not status checks.

Assess Your Prior Authorization Workflow

The Business Problem

Prior authorization is one of the most burdensome administrative tasks in healthcare. Physicians spend an average of 14 hours per week on PA-related activities. The process is manual, inconsistent, and opaque — every payer has different forms, portals, and timelines. PA-related denials occur when services are scheduled without checking auth requirements or when submissions are incomplete.

Affected Team

Front desk, scheduling, clinical staff, and billing. The burden spans the entire patient journey from scheduling through claim submission. Clinical staff time spent on PA is time not spent on patient care.

How It Works

Current Manual Workflow

A scheduler books a procedure. Someone must check if the service requires prior authorization for the patient's payer. If yes, they gather clinical documentation, complete the payer-specific form, submit via portal or fax, and then manually track approval status by periodically checking the portal or calling the payer. If approved, the procedure proceeds. If denied or pending, the process repeats.

Automated Workflow with Sarva

When a provider orders a service, Sarva checks whether authorization is required for the patient's payer and plan. If required, Sarva auto-generates the submission package — clinical documentation, supporting codes, payer-specific narrative — and submits through the payer's preferred channel. Sarva tracks approval status automatically and escalates only when intervention is needed or a deadline is approaching.

Inputs

Ordered service and CPT/HCPCS codes
Patient insurance information
Payer-specific PA requirements library
Clinical documentation supporting medical necessity
Provider orders and notes

Outputs

Auto-generated PA submission package
Submitted authorization request
Real-time approval status tracking
Pending/escalation alerts
Approval documentation for the claim

Human Oversight

Sarva escalates to staff when a PA is denied, when additional information is requested by the payer, or when a deadline is approaching. Staff handle exceptions and peer-to-peer reviews. The system manages routine submissions and status tracking without staff involvement.

Security Considerations

All clinical documentation and patient data is encrypted in transit and at rest. PA submissions contain PHI and are handled under the same HIPAA standards as all Sarva operations. BAA included. SOC 2 Type II certified.

Integration Considerations

Sarva integrates with your EHR to detect ordered services and retrieve clinical documentation. PA submissions are made through payer portals, EDI transactions, or API connections where available. The PA requirements library is continuously updated as payer policies change.

Limitations

Not all payers support electronic PA submission. Some require fax or portal-only submission, which Sarva handles but with longer processing times. Peer-to-peer reviews require physician involvement and cannot be automated. PA requirements change frequently and occasionally the library may lag behind a payer's latest policy update.

Key Performance Indicators

PA-related denial rate

Target

< 2%

Staff time on authorizations

Target

70% reduction

PA turnaround time

Target

< 48 hours for routine

Auto-submission rate

Target

> 80%

See how this workflow applies to your practice.

Assess Your Prior Authorization Workflow

Related Connectors

Frequently Asked Questions

Sarva maintains a continuously updated library of payer-specific PA requirements. When a provider orders a service, Sarva checks the library for the patient's payer and plan to determine if authorization is required. The library is updated as payer policies change.

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