Tier-1 Healthcare Assessment
Prior Authorization is a workflow problem before it is an automation problem.
A fixed-scope assessment for prior authorization, utilization management, and provider operations leaders. It diagnoses administrative burden, denial drivers, exception handling, and human dependency risk — so you can fix operational quality before spending on AI, automation, FHIR, or Gold Card programs.
Investment
$5K-$8K
Timeline
1 week
Service Role
Healthcare assessment wedge
The Wedge
Gold Card eligibility is not the problem. Operational quality is the problem.
Practice administrators do not wake up asking for Gold Card programs, FHIR integrations, or prior authorization platforms. They feel administrative burden, denial friction, staff dependency, and workflow inconsistency first.
- Why are we getting denied?
- Why does authorization take so long?
- Why is staff spending hours on manual work?
- Why do some providers get approved and others do not?
- Why do certain payers constantly create friction?
- Why is work dependent on specific people?
Inputs
What the assessment works from.
The assessment uses operational evidence you already have. No new platform, integration, or instrumentation is required to begin.
Prior authorization submissions
Denial reasons
Specialty mix
Payer mix
Workflow documentation
Staffing model
Outputs
Five operational findings, not a platform pitch.
Administrative Burden Analysis
Volume, effort, turnaround time, and exception frequency across the authorization workflow.
Denial Analysis
Documentation, coding, eligibility, and medical-necessity drivers behind denials.
Exception Analysis
Repeat patterns, recurring bottlenecks, and the escalation paths the team relies on.
Human API Risk Analysis
Who knows payer-specific rules, handles exceptions, performs escalations, and trains staff — and what happens if they leave.
Gold Card Readiness Assessment
Approval quality, workflow standardization, documentation quality, and operational maturity. Readiness is an output of operational quality, not a product.
The Human API
Organizations often believe they have a workflow. In reality they have a person.
Every authorization team typically contains one or two people who carry the operating model in their heads. That dependency is one of healthcare's strongest hidden operational risks.
- Know payer-specific workflows
- Know escalation paths
- Know exception handling
- Know documentation requirements
The assessment makes that dependency visible — who holds payer-specific knowledge, who handles exceptions, who escalates, who trains — and what breaks if they become unavailable.
FAQ
Questions buyers should resolve before intake.
Is this a Gold Card, prior authorization, or claims platform?+
No. This is an operational assessment, not software. It does not include a Gold Card platform, prior authorization automation product, FHIR infrastructure, claims integration, or payer technology product. It diagnoses operational quality before any of those decisions.
How is this different from the Operational Recovery Assessment?+
It is the same fixed-scope, one-week assessment motion, specialized for prior authorization. It uses PA submissions, denial reasons, payer mix, and staffing as inputs, and produces administrative burden, denial, exception, Human API, and Gold Card readiness findings.
Do we need AI or automation in place first?+
No. Prior authorization is a workflow modernization problem before it is an AI problem. AI and automation help only after the workflow is decomposed into decision tiers, escalation paths, audit requirements, exception handling, and human review points.
Do you need verified outcome metrics from us?+
The assessment works from your existing PA submissions, denial reasons, and workflow documentation. TKO does not publish your savings, turnaround, denial-rate, or program results without your explicit approval.
Operational Recovery Assessment
Diagnose operational quality before you buy automation.
The Prior Authorization Operational Assessment maps administrative burden, denial drivers, exception patterns, and human dependency risk in one fixed-scope week — and shows leadership the next highest-leverage move.