Prior Authorization Recovery · Contingency-Based

Your practice has already
earned this revenue.
We recover it.

Stratum Health Intelligence is a specialty prior authorization recovery service for medical practices. When payers deny authorizations your physicians worked hard to justify, we appeal — and we only invoice when we win.

Start with a Free Denial Audit See How It Works
The Gap We Close
80%+
Of appealed denials overturned when properly documented
11.5%
Of denials ever formally appealed — the rest are written off
25–35%
PA denial rate in orthopedics — among the highest of any specialty
$0
Your cost if we don't win. No win, no fee. Always.
"Most denials are not lost causes — they are lost because no one had time to fight them properly."
The Problem

Prior authorization denials are
costing you more than you think.

25–35%
Denial Rate in Surgical Specialties
Payers deny a significant portion of prior authorization requests for surgical procedures — particularly in high-volume specialties like orthopedics, spine, and sports medicine. The complexity of these cases makes them prime targets for algorithmic auto-denial systems.
80%+
Appeal Overturn Rate When Properly Filed
When denials are formally appealed with complete clinical documentation and payer-specific language, the majority are overturned. The evidence supports the procedures — the appeals just need to be written correctly.
11.5%
Of Denials Are Ever Formally Appealed
The overwhelming majority of denied authorizations are written off without ever being appealed. Not because they cannot be won — but because your billing staff does not have the bandwidth to write optimized appeal letters on top of everything else they manage.
$19.7B
Spent Annually on Claim Reconsiderations
Across U.S. healthcare, practices and health systems spend nearly $20 billion each year pursuing denied claims. This cost falls disproportionately on smaller independent practices who lack dedicated appeal infrastructure.
The Core Issue
"Payers count on low appeal rates. Their denial systems are designed to discourage follow-through. Every unappealed denial is revenue your practice earned but will never collect."
— Stratum Health Intelligence
For a practice with four physicians handling 150+ prior authorization requests per week, a conservative 8% denial rate generates approximately 50 denied cases per month. At an average recovered value of $1,500 per surgical procedure, that represents up to $75,000 in monthly recoverable revenue sitting in unappealed denials. Most of it is never challenged.
Our Services

A complete recovery
service. Three parts.

Every client receives all three components as a unified service. The audit opens the relationship. The appeals recover the revenue. The report keeps you informed — every single month.
01
Free Denial Audit
Before you sign anything or share any patient data, we review your last 30–60 days of denied prior authorizations. We identify recoverable cases, estimate potential revenue, and present our findings. You see exactly what is on the table — at no cost, with no obligation to proceed.

This is how every engagement begins. No PHI required. No commitment needed.
Free — Every Prospect
02
Prior Authorization Appeals
When a denial comes in, your billing staff submits our secure intake form — approximately 10 minutes. We handle everything after that: drafting, submission, and tracking through resolution.

You do not touch a payer portal. We only invoice when the appeal is won.
20% of Recovered Revenue
03
Monthly Results Report
Every month, delivered alongside your invoice, you receive a one-page results report showing: total appeals filed, wins and losses, total revenue recovered, your Stratum fee, a breakdown by payer, and trend data versus prior month.

Full transparency, every billing cycle. No surprises.
Included — No Extra Cost
The Process

From denial to resolution —
four steps.

Your staff handles one step. We handle the rest.

01
Stratum
BAA Executed
Before any patient information is shared, we sign a Business Associate Agreement. This is a HIPAA requirement and a non-negotiable precondition of every engagement. It happens once at the start of the relationship.
02
Your Staff
Denial Submitted
When a qualifying denial comes in, your billing contact submits it through our secure intake process. That is the full extent of your team's involvement per case — approximately 10 minutes.
03
Stratum
We Handle the Appeal
We prepare, review, and submit a specialist-level appeal on your behalf. Every letter receives personal review before it goes out. We track the case and follow up with the payer through resolution — you will not have to chase us.
04
Stratum
Outcome & Invoice
Win: authorization confirmed, procedure scheduled, revenue collected. Stratum invoices 20% alongside your monthly results report. Loss: no invoice issued. You owe nothing at any stage.
Pricing

The no-risk model.
You pay when we win.

20
%
of recovered procedure revenue — only when we win
"An unappealed denial is $0 recovered. A won appeal at 20% means you keep 80% of revenue you would not have collected otherwise."
Example
Rotator cuff repair approved at $4,500 reimbursement.
Your practice keeps: $3,600
Stratum fee: $900
Without Stratum: $0
What is always included
  • Free denial audit — no obligation, no PHI required
  • No fee if the appeal is denied at any level
  • No setup fee or onboarding cost
  • No monthly retainer
  • No long-term contract
  • No minimum case volume
  • Monthly results report included
  • Second-level appeal escalation at no extra cost
Fee Structure — Phase Progression
Phase 1 — Current Pure contingency, 20%
Phase 2 Setup fee + 20%
Phase 3 Retainer option available
Specialties We Serve

Built for any specialty
with a high denial burden.

Prior authorization denials hit hardest in surgical and procedural specialties where documentation requirements are complex and payer scrutiny is aggressive. We are built for exactly those practices.
🦴
Orthopedic Surgery
Joint replacement, arthroscopy, sports medicine, trauma — among the highest denial rates of any specialty.
Active Focus
🧠
Spine Surgery
Fusion, laminectomy, discectomy — high-value procedures with aggressive MA plan scrutiny.
Expanding
🏃
Sports Medicine
Labrum repair, ligament reconstruction, cartilage procedures — high documentation burden.
Expanding
💉
Pain Management
Interventional procedures, implant therapies, and injection protocols with complex payer criteria.
Expanding
Not seeing your specialty? If your practice handles high-volume prior authorization requests in a surgical or procedural setting, the Stratum model likely applies. Contact us and we will assess your denial profile through the free audit before you commit to anything.
HIPAA & Compliance

Your patients' data
protected at every step.

We take compliance as seriously as you do. Here is exactly how patient data is handled throughout the entire workflow.

🔒
BAA Before Anything
A Business Associate Agreement is executed with your practice before a single piece of patient information is shared. This is a legal HIPAA requirement and a non-negotiable precondition of every Stratum engagement — without exception.
🛡️
Encrypted Infrastructure
All patient information submitted through our intake process is handled via encrypted Google Workspace infrastructure. Document uploads are stored in access-controlled, practice-specific folders. Data is never stored beyond the case resolution period.
⚙️
Controlled Data Handling
Patient information is handled through a structured, multi-step internal workflow that limits exposure at every stage. Clinical information used in the appeal process is managed under strict access controls, and no data is retained beyond the case resolution period.
👁️
Human Review on Every Letter
Every appeal letter is personally reviewed by a specialist before submission. This is not an automated pipeline. Every case receives dedicated human attention — ensuring accuracy, clinical alignment, and professional quality on every submission.
Our compliance framework has been reviewed by a HIPAA compliance attorney.
Documentation available to prospective clients upon request.
Request Compliance Documentation
About Stratum

Built around one
simple observation.

The majority of denied prior authorizations can be overturned. They just need someone with the time, expertise, and singular focus to fight them correctly. Most practices have none of that bandwidth to spare.

Stratum was built to bridge that gap. We are not a generalist billing company with appeals as a checkbox service. Prior authorization recovery is our entire focus — and our contingency model means our financial incentive is perfectly aligned with yours.

We work with specialty medical practices where prior authorization burden is highest and where unappealed denials represent the largest concentration of recoverable revenue. Our background spans both clinical and administrative healthcare — we read denial letters the way payer reviewers do, and we write appeals accordingly.

Aligned IncentivesWe only get paid when you get paid. There is no scenario where our interests and yours are not perfectly aligned.
Clinical UnderstandingDirect healthcare experience informs how we interpret denial letters, engage with clinical criteria, and build appeals that speak the payer's language.
Full TransparencyMonthly results reports mean you always know exactly what was recovered, what was filed, and what it cost. No black boxes, ever.
Our Position
"We are not an add-on to your billing operation. We are a specialist service for a specific problem — one that your current setup was never designed to solve at this level."
What You Can Always Expect
  • Personal review on every appeal letter before submission
  • 48–72 hour turnaround on standard cases
  • Proactive payer follow-up — you will not have to chase us
  • Clear communication on every outcome
  • A monthly report that tells the full story
  • Zero invoice if the appeal does not succeed
Get Started

Start with a free
denial audit.

No PHI required. No obligation. We review your denial history and show you what is recoverable — before you commit to anything.

✉
Email
guillermo@stratumhealthintelligence.com
📍
Location
Central Florida · Fully Remote Operations
⚡
Response Time
Within 24 hours on all inquiries
What the Free Audit Covers
Your last 30–60 days of denied prior authorizations reviewed — no PHI needed.
We identify recoverable cases, estimate potential revenue, and show you exactly what we would focus on before you commit to anything. Results delivered within 5 business days.
Get in Touch

Ready to recover your denied prior authorizations?
Reach out directly and we'll get back to you within 24 hours.

✉ guillermo@stratumhealthintelligence.com