Stop guessing. Start knowing.
Prior authorization shouldn't require hunting through PDFs, payer portals, or guessing what the payer considers "medically necessary". CoveredOrNot shows you the actual payer criteria — so you can submit with confidence and respond with precision.
View specific prior authorization criteria for your selected payer and service
Upload patient record and receive detailed gap analysis against requirements
Generate and download your medical necessity letter ready for submission
Understand the payer's requirements before submitting. When denied, get a clear explanation of the gaps and fixes.
Increase your team's productivity with tailored automation. Verify prior authorization submissions against payer's criteria to avoid denials.
Organize your criteria and knowledge in an AI-ready format to support adjudication automation and analytics. CoveredOrNot is a CMS-0057-F (Prior Authorization API) solution.
Check payer criteria against the patient record and generate a medical necessity letter when ready.
See the payer's prior authorization criteria for the requested drug/procedure/equipment, compare them to the patient's record and see gaps. When ready, get a medical necessity letter to send.
Upload a denial letter to get an explanation and a ready-to-send appeal mapped to the denial reason.
Upload the denial letter and get an explanation of the denial reasons, and instructions on addressing them. Finally, get an appeal letter to send.
Get insights into which criteria are driving denials and how to optimize your submissions.
Get criterion-level visibility into your prior authorization process – Which criterion makes the biggest difference? Which criteria are redundant? To optimize your prior authorization process and requirements.
We handle your denied prior authorizations and only charge if the appeal succeeds.
Denials sitting unhandled in your account receivables? CoveredOrNot will take your denied prior authorization requests, fight them on your behalf and charge a contingency fee only when successful. Get your patients the care they need and increase your revenue stream with no risk to you.
CoveredOrNot uses HIPAA compliant infrastructure and strictly US-based staff. On-premises deployment is available – contact us.
Browse and inspect thousands of criteria from commercial and Medicare payers.
Compare a patient against a payer's drug/procedure/equipment criteria.
Analyze denial reasons and compare a patient against them.
Pay only when the denial is overturned. If you do not see revenue, you are not paying for trying.
Let us handle your denials with no upfront cost.
Sign Up for Service AgreementCoveredOrNot is a US-based company on a mission to help patients, providers, and payers understand and streamline prior authorization. We believe in transparency, efficiency, and empowering healthcare professionals with the right information at the right time.