OrthoRelay
Prior Authorization Automation
Prior Auth Automation for Specialty Clinics

Prior Auth. Built for Texas Orthopedics.

Built for Texas ortho clinics: BCBS‑TX & UHC rules, faster first‑pass approvals, and fewer preventable denials. OrthoRelay extracts data, checks payer rules, and builds compliant packets—so your team spends minutes, not hours.

HIPAA compliant · Encrypted · SOC 2 roadmap
Request Access for Your Clinic See the Demo

Why prior auth drains your team

Auths vary by payer and plan. Staff re‑key EMR data, chase checklists, and fight denials from missing elements.

Time sink

30–90 minutes per auth across faxes, portals, and phone trees.

Preventable denials

Missing notes, LoMN, or imaging evidence lead to rework and cancellations.

Inconsistent packets

Every payer/plan is different. Results vary by staffer and day.

How OrthoRelay works

From intake to packet — standardized and compliant, ready to submit.

1

Upload docs

Intake PDFs from fax/email or export from your EMR.

2

AI extracts & checks rules

Pulls CPT/ICD, member/provider details, and maps payer/plan policy to a checklist.

3

Builds compliant packet

Auto‑fills payer forms and assembles a standardized PDF with required attachments.

4

Track & submit

Submission instructions today; portal automation and live status logs next.

Built for Texas Payers

We've mapped BCBS-TX and UHC commercial prior auth rules for orthopedic procedures — and we're building Texas Medicaid STAR coverage next. Because your PA burden doesn't stop at commercial insurance.

Blue Cross Blue Shield of Texas

Live Coverage
596 prior auth rules mapped · ~27% of TX commercial insured
  • Knee MRI (73721)
  • Shoulder Arthroscopy (29827)
  • TKA (27447)
  • Lumbar Fusion (22633)
  • SI Joint Injection (27096)

UnitedHealthcare (Texas)

Live Coverage
2,701 prior auth rules mapped · ~25% of TX commercial insured
  • Knee MRI (73721)
  • Shoulder Arthroscopy (29827)
  • TKA (27447)
  • Lumbar Fusion (22633)
  • SI Joint Injection (27096)

Texas Medicaid (STAR & STAR+PLUS)

Coming Q3 2026
MCO-specific PA rules vary by plan — we're mapping them now · ~5.7M TX Medicaid enrollees
  • UHC Community Plan
  • Molina Healthcare
  • Superior Health Plan (Centene)
  • Aetna Better Health TX
Gold Card exemption does not apply to Medicaid — every submission matters
Aetna TX (Commercial) Cigna TX Medicare Advantage
Rules updated from official payer policy documents. Coverage includes CPT codes for imaging, MSK surgery, injections, DME, and spine procedures.

See it in action

From patient chart to compliant packet in minutes — not hours.

Texas Exclusive Feature

Track Your Path to Texas Gold Card Status

Texas law requires payers to waive prior auth for physicians with a 90%+ approval rate. Most clinics don't know where they stand. We show you — physician by physician, payer by payer.

Gold Card Status Dashboard
Updated daily
Physician Payer Approval Rate Submissions Status
Dr. Sarah Mitchell BCBS-TX 94% 47 Gold Card Active ✓
Dr. James Ortega BCBS-TX 87% 31 3% to qualify
Dr. Sarah Mitchell UHC 91% 38 Gold Card Active ✓
Dr. James Ortega UHC 76% 18 Building history
💡 Dr. Ortega needs 4 more clean BCBS-TX approvals to qualify. We'll flag the next submission for extra packet review.
  • Automatic 6-month rolling approval rate calculation per physician per payer
  • Alerts when a physician is within 5% of Gold Card threshold
  • Exemption tracking — know when your Gold Cards expire before the payer tells you

Built for Texas Orthopedic Clinics

Built specifically for Texas orthopedic service lines (BCBS‑TX & UHC supported).

Orthopedic Surgery Sports Medicine Spine Surgery Pain Management

How we work with your clinic

No shadow IT. Proper compliance from day one.

1

Your team requests access

PA coordinator or office manager fills out the form to start your pilot.

2

We set up your clinic

BAA signed, accounts created, payer rules configured, staff onboarded.

3

Your team starts saving hours

Upload docs, get compliant packets, reduce denials — track status end‑to‑end.

ROI you can measure in weeks

Early pilots show faster prep, fewer reschedules, and clearer ETAs for schedulers and surgeons.

30–90 min → <15 min
Time per prior auth
50–70% ↓
Time reduction with OrthoRelay
3,297
Payer rules loaded (BCBS‑TX + UHC)
HIPAA compliant controls Encryption at rest & in transit SOC 2 Type II roadmap BAA available Role-based access

Request Access for Your Clinic

We'll reach out within 24 hours to set up your clinic's pilot.

We'll reach out within 24 hours to set up your clinic's pilot.