Packet gap
Conservative treatment evidence needs review
Advanced imaging packet matched against the bundled orthopedic imaging rule.
Offline installable prior-auth readiness
Prior auth packet checks that stay on the device.
PriorAuth Guard helps access, billing, and clinical support teams find missing documentation before submission using local payer rules, signed updates, and tamper-evident receipts.
- No PHI upload
- No accounts
- No tracking SDKs
- Signed rule updates
Local packet review
offline-ready
Local rules active with signed network updates available.
Completion history is kept in encrypted local storage.
Clinical note found
CPT group matched
Manual review flagged
Privacy boundary
Useful checks without turning every packet into a cloud upload.
No PHI upload for packet evaluation
The installed app evaluates packets locally by design. Documents, packets, receipts, and audit logs remain on the device unless your organization chooses otherwise.
Deterministic rule behavior
Bundled payer packs and Ed25519-signed updates keep the rule path explainable, auditable, and protected from untrusted network changes.
Local accountability trail
Encrypted local storage and tamper-evident audit history help teams show what was checked before payer submission.
Bringing this to a security review? The security page lists the primitives and their parameters, states the limits, and shows how to verify each claim in your own browser.
Front-desk to billing workflow
A quieter way to catch packet issues while they are still fixable.
The app focuses on the moment before submission: the practical handoff between payer rules, documentation evidence, and staff time.
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01
Create the packet
Select payer, plan, specialty, CPT codes, and site of care from supported rule values.
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02
Add documentation
Capture or upload documents, then review extracted and manually entered fields.
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03
Run completeness checks
See what appears satisfied and which gaps need correction before submission starts.
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04
Save the receipt
Generate a signed completion receipt and local audit trail for internal accountability.
Install from the website
Use it in browser today. Install it where the work happens.
PriorAuth Guard runs as a website-installed app. After install, teams can keep working from the local app surface with bundled rules and one-way signed rule updates.
Production safeguards
- No user accounts or tracking SDKs
- Encrypted local storage
- Tamper-evident audit history
- Ed25519-signed rule updates
Current runtime coverage
Focused payer-rule coverage, designed to grow by signed update.
The current runtime loads 12 bundled payer packs, 47 payer rules, one document completeness rule, and one CPT group for advanced imaging workflows.
- 12
- payer packs
- 47
- payer rules
- 1
- doc completeness rule
- 1
- CPT group
Payer-plan packs available now
Eight payer families across 12 local packs
- UnitedHealthcare
- Aetna
- Anthem Blue Cross
- Blue Cross Blue Shield
- Cigna / Evernorth
- Humana
- Kaiser Permanente
- Centene / WellCare
What every packet check covers
Core authorization facts, checked consistently
- Payer, plan, and region match
- Authorization presence
- Site-of-care match
- CPT and authorized-date checks
Detailed document-level completeness is currently focused on UnitedHealthcare orthopedic advanced imaging (10 CPT codes). Other packs provide the core authorization checks above; they are not represented as full payer policy libraries.
Path to live payer requirements
Signed updates now. Payer API connections as they become usable.
PriorAuth Guard already downloads one-way signed rule updates without sending packet or patient data. The next step is replacing manual source collection with verified payer API inputs while preserving review and the local privacy boundary.
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Reviewed, signed rule releases
Bundled rules and network updates are signature-checked before they become active. Payer source collection and normalization still require human review.
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CMS API compliance begins
Impacted Medicare Advantage, Medicaid, CHIP, and federally facilitated Exchange plans must begin supporting FHIR prior-authorization APIs for non-drug items and services. Exact timing varies by payer category.
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After validation
Payer-by-payer live ingestion
We can connect each production endpoint after access, authentication, coverage scope, and data quality are verified. We then normalize, test, sign, and publish updates to devices.
What the 2027 date means
CMS requires impacted payers' APIs to identify covered items and services, documentation requirements, and request status. It does not require every payer or every commercial plan to participate, and it does not require instant decisions. January 1 is the start of a payer-by-payer integration window, not an automatic switch from manual rules to universal live data.
Hospital denial prevention
Fix the packet before it becomes a denial.
Hospitals spent $43 billion in 2025 trying to collect insurer payments for care already delivered, including nearly $18 billion overturning denied claims. PriorAuth Guard checks supported packets before submission so teams can catch missing documentation and rule mismatches before they become appeals, delayed payment, or lost revenue.
- $43B
- spent chasing insurer payments
- $18B
- spent overturning denials
- 70%
- of denied claims ultimately paid after review
Prefer a direct introduction? James@execlayer.io
Ready before the payer sees it
Start locally. Pilot it with your hospital.
Run a packet check in the browser today, or schedule a hospital pilot discussion around your service line and payer mix.