Every payer has specific clinical criteria that determine approval — buried in hundreds of pages your team doesn't have time to decode. Navigator maps the exact thresholds, documentation requirements, and hard stops for every major surgical CPT code, by payer, in 60 seconds.
Required: Cotinine <10 ng/mL within 6 weeks. No test on file.
Required: >50% supervised PT. Home exercise documented — does not qualify.
One surgical case. Two paths. Thousands of dollars in difference.
Instant requirement analysis: 25% approval probability. DO NOT SUBMIT.
4 missing requirements identified: Cotinine test absent. Conservative care is home exercise only — does not satisfy supervised PT requirement. Therapist discharge summary missing.
Staff collects missing lab results and therapist notes based on exact documented thresholds.
Surgery proceeds on schedule. No appeals. No delays. No lost revenue.
Staff submits via portal with generic surgeon notes and MRI report — no knowledge of specific criteria.
"Does not meet clinical criteria for CPT 22633."
Staff spends hours researching 80-page PDFs, calling payer lines, chasing therapist records.
OR schedule disrupted. Patient frustrated. Revenue at risk while appeal cycles through payer review.
Your team isn't making mistakes. The system is designed to be opaque.
The rules are buried in hundreds of pages of policy documents, written in legal jargon, cross-enforced across delegation entities. Even the most experienced billers are working with incomplete information. Navigator makes the hidden rules visible, so every submission starts from a position of complete knowledge.
That's not a training problem. That's an intelligence gap. And until now, no tool existed to close it.
Enter a CPT code and payer. Navigator returns the exact requirements — quantitative thresholds, documentation sources, routing rules, and hard stops — with pass/fail status on every criterion.
This is Tier 1 — Quick Validation. For complete procedure understanding and AI consultation, see Tier 2 and Tier 3 below.
Intelligence Reports give you the complete picture for every procedure and payer — not just what's missing at submission, but the full landscape of how authorization actually works. Click any section below to see real data from CPT 27447 (Aetna).
This intelligence exists for every surgical CPT code across every major payer. No other product offers this. At any price.
View Sample ReportEvery data point originates from the exact policy document, section, and verbatim language it came from. Hover to see the proof.
Requirements — hover 🔒 to verify any source
Hover the 🔒 above to see a live Source Lock™ verification
Every practice eventually asks: "How do we know this data is accurate?"
With other tools, the answer is:
With Navigator, the answer is: "Hover over it."
Every requirement shows:
With Navigator, you never have to take our word for it. Every requirement is traceable to its source — the exact policy, section, and language.
Your compliance team can verify in seconds. Your staff can answer "how do you know?" on the spot.
Source-locked AI consultation for the questions your checklist can't answer — grounded in verified policy intelligence, not the open internet.
Your staff hits an edge case:
Without Tier 3:
Staff guesses — and likely loses the revenue
Call the payer — wait on hold for 45 minutes
Billing consultant at $200/hour — and wait days
None of these are fast. None are free. None are reliable.
Generic AI
Navigator AI Policy Advisor
This isn't a chatbot. This is verified intelligence consultation.
Generic tools tell you if prior auth is needed. Navigator tells you how to get it approved — at three levels of depth no other platform offers.
Basic binary check only — tells you IF, not HOW.
Vague criteria, no thresholds, no documentation specifics.
"Cotinine <10 ng/mL, BMI <40, 6 weeks supervised PT" — pass/fail in 60 seconds.
The full approval landscape — routing entities, documentation sources, 15+ denial traps.
Instant expert answers grounded in verified policy data — never the open internet.
"This routes through eviCore CMM-601, not Aetna direct" — automatically surfaced.
Hover to verify. Every requirement traceable to exact policy, section, and language.
Three depths of intelligence — from 60-second claim validation to complete procedure understanding to AI-powered consultation. Every tier includes Source Lock™ verification on every data point. Start where it fits. Upgrade as you grow.
Instantly validates every CPT requirement against exact payer thresholds so your billers know what's missing — before it becomes a denial.
Gives every team member the full picture: pathways, denial traps, documentation source requirements, and appeal tactics that work by payer.
Source-locked AI consultation on your hardest edge cases — no hallucinations, no consultant fees, no waiting. If it doesn't know, it tells you.
| Capability | Other PA Tools (Waystar, Myndshft, etc.) |
Navigator T1 Approval Checklist |
Navigator T2 Intelligence Reports |
Navigator T3 AI Policy Advisor |
|---|---|---|---|---|
| Prior auth required flag | ||||
| Exact quantitative thresholds | ||||
| Delegation routing (eviCore, AIM, Carelon) | ||||
| Warning flags ranked by denial risk | ||||
| Source Lock™ — hover to verify every data point | ||||
| Coverage determination pathways (Standard vs. High-Risk) | ||||
| Documentation source requirements (therapist vs. surgeon) | ||||
| Appeal tactics by payer with citations | ||||
| Policy alerts & regulatory intelligence (OIG, CMS) | ||||
| Source-locked AI consultation on edge cases | ||||
| AI grounded in verified policy — no hallucinations | ||||
| Pricing | Varies | $175/provider/mo | $325/provider/mo | $450/provider/mo |
At 50–70% denial reduction, Navigator pays for itself in under two weeks at every tier.
11 specialties. All major payers. Every procedure mapped from launch.
AI-powered policy updates · Always current · SOC 2 Type I certified
Navigator meets every member of your team at the level of intelligence they need.
"Know before you submit — every time."
60-second validation before every submission. Pass/fail against exact payer requirements. Instant action items when gaps exist.
"Understand root causes. Train systematically. Stop the pattern."
Procedure-level understanding of how approvals work. Root cause analysis for recurring denial patterns. No more learning by trial and error.
"Read once per procedure type. Never be surprised again."
Complete approval landscape before scheduling. P2P preparation intelligence. Full documentation visibility — from your note to the therapist's discharge summary.
"Your hardest edge case answered in seconds."
Instant source-locked consultation on unusual presentations. No more guessing, no hold times, no consultant fees.
Estimate your annual return based on practice size.
Join the practices already in early access to Navigator — and be among the first to prevent denials before they happen.