The structure they didn't know was missing.

The Vascular Care Group, the largest independent vascular surgery group in the country, is a multi-state group with over 30 providers performing procedural volume across multiple sites of care. At that scale, prior authorization stops being a task and becomes an operating system—and before Aira, that system was held together by different portals, a daily report, and institutional memory.

With Aira, the group moved authorization work upstream: clinical records reviewed before submission, and cases at high risk of denial flagged immediately. On top of that, efficiency and automation reduced the number of clicks staff have to endure.

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The Challenge

Vascular surgery carries one of the highest prior authorization denial rates in medicine. Medical necessity criteria are dense, payer-specific, and revised frequently—a case that cleared policy last quarter may not clear it today. The result is a workflow where staff spend their day chasing requirements, and where revenue is lost to process rather than clinical judgment.

The Solution

Aira was deployed as the layer between clinical documentation and payer submission—running order intake, medical necessity review, submission, tracking, and appeals in one workflow.

• Pre-Submission Record Review — Aira reviews the medical record against payer-specific medical necessity criteria before anything is submitted. Gaps are surfaced immediately to avoid back-and-forth with payers.
• Structured Appeal Workflow — Denials land in the workboard as Action Required, with a recommended next step: appeal or peer-to-peer. Aira drafts the appeal letter from the clinical record and the payer's stated rationale.
• Analytics & Denial Pattern Reporting — Aira reports analytics across payers and procedures, including denial patterns, so template and documentation weaknesses get fixed at the source.

The Impact

Metric	Before Aira → With Aira
First-Pass Approval Rate	Industry baseline ~70–80% → 97%
Auth Tracking	Manual report, reviewed daily, unstructured payer responses → Centralized workboard with proactive flagging and a system of record with structured responses
Documentation Gaps	Caught post-denial → Caught pre-submission
Appeals	Ad hoc, built from scratch → Structured workflow
Staff Time per Order	Manual, ~20–30 minutes → at least 15 minutes saved per order, with greater savings on complex payers and procedures