Caldarium: Prior Authorization, Done Right

Prior authorization, done right

Stop losing revenue to prior auth denials.

Caldarium gets prior authorizations right the first time: flagged early, built complete from the chart, tracked to approval. Starting where the stakes are highest: infusion.

SCROLL

prior authorizations per physician, every week

AMERICAN MEDICAL ASSOCIATION, 2025

13 hrs

per physician, per week, spent on prior authorization

AMERICAN MEDICAL ASSOCIATION, 2025

11.5% → 80.7%

of denials get appealed. Of those, four in five are overturned.

MEDICARE ADVANTAGE PRIOR AUTHORIZATION DATA

Most prior auth denials are documentation failures, not clinical ones.

Care gets delayed or denied because the paperwork is incomplete, fragmented, or misaligned with what the payer requires, and most EHRs can't catch that before a request goes out.

01 · CHECK

Know before the visit.

For each order, Caldarium checks the service, drug, payer, and plan, then flags the cases that require an authorization. Before the visit, not after the claim.

02 · REVIEW

It reads the chart for you.

Notes, labs, and history: pulled from the chart and mapped, line by line, to the payer's medical-necessity criteria.

03 · RESOLVE

Deficiencies surface before submission.

Anything missing is flagged while there's still time to fix it. Your staff resolve the deficiency in minutes, before the request, not the denial, goes out.

04 · TRACK

Tracked to approval.

Every authorization in one view: submitted, in review, approved. Nothing slips past the service date. Nothing sits forgotten in a queue.

IN REVIEW

APPROVED

PATIENT · 45 M PROCEDURE · INFLIXIMAB PAYER · KEYSTONE PLAN · MEDICARE ADV

Submission readiness PA REQUIRED

Infliximab (Remicade) Infusion · HCPCS J1745

Signed physician's order on file✓ SATISFIED

Covered ICD-10 indication for J1745 ! MISSING ✓ SATISFIED

Baseline labs current (CBC, LFTs, hepatitis B) ! MISSING ✓ SATISFIED

Prescriber meets specialty requirement✓ SATISFIED

! 2 clinical documentation deficiencies pending resolution

✓ 0 deficiencies: ready to submit

Approved

Why nobody catches this today

Your systems each hold one piece of the answer.

The problems live in the space between your EHR, your scheduler, and the authorization itself, which is why no single vendor in your stack can catch them.

SCHEDULE × AUTHORIZATION

Treatment gets rescheduled past the approved date window.

WHAT CALDARIUM DOES

Flags it days ahead, while there is still time to extend the authorization.

CHART × AUTHORIZATION

What actually happened differs from what was authorized.

WHAT CALDARIUM DOES

Surfaces the mismatch the same day, while a corrected authorization is still possible.

ORDER × PAYER RULE

The order is missing evidence the payer requires.

WHAT CALDARIUM DOES

Names exactly what is missing before scheduling, so your team asks the provider once.

Use cases

Starting with infusion. Expanding from there.

Caldarium begins where documentation quality hits revenue hardest, then extends to the procedures where a missed clause costs the most.

01 LIVE NOW

Infusion & Specialty Medications

High-cost biologics demand extensive clinical justification, step-therapy history, and supporting evidence. This is where Caldarium proves its value first.

02 EXPANDING NEXT

High-Margin Procedures

Transplants, cardiac, and other high-value services carry the largest financial impact when gaps lead to denials or delays.

03 ON THE ROADMAP

Denial Management & Appeals

When a request is denied, Caldarium drafts a citation-backed appeal from the same clinical record, ready for staff review and resubmission.

04 ON THE ROADMAP

Concurrent & Retrospective Review

As treatment continues, Caldarium tracks ongoing medical necessity against payer criteria, flagging documentation to renew before authorization lapses.

How it fits

It sits between your record and your payer.

Caldarium reads from the systems you already have and hands findings back to the person already doing the work. You keep submitting exactly the way you submit today.

YOUR SYSTEMS

EHR & clinical notes

Scheduling

Active authorizations

READS

CALDARIUM

Checks every request against payer requirements, before and after approval.

RETURNS

YOUR TEAM

A list of what to fix

Who owns it

How long is left

Nothing gets re-keyed. No one learns a second workflow. Submission still happens wherever it happens today — a payer portal, a phone call, a clearinghouse, or your EHR's own module.

Outcomes

Fewer denials. Less busywork. Clearer visibility.

Fewer avoidable denials

Complete, guideline-aligned requests mean fewer denials on the cases that matter most.

Less rework per case

Avoid the review, resubmission, and appeal cycles that drain staff time and slow throughput.

Visibility into every case

See which cases need a PA, each request's status, and whether documentation is complete.

Revenue saved

Complete, on-time submissions mean more of what you bill actually gets paid: real savings, not just fewer losses.

Start here

Get a Prior Auth Diagnostic.

A one-time, no-obligation assessment of your prior auth workflow, starting with infusion, where leakage is usually largest. We map where revenue is leaking and where delays are avoidable, specific to your practice.

We review your workflow

How authorizations are checked, assembled, submitted, and tracked today, including where your EHR falls short.

We find the leakage

Where denials, delays, and rework are costing you revenue and staff hours, quantified, not guessed.

You get a written report

A clear summary of findings and the highest-impact fixes, yours to keep, whether or not we work together.

Book your Diagnostic

LIVE AVAILABILITY

NO OBLIGATION · 30 MINUTES · PICK A TIME BELOW

Why now

Prior auth is going electronic. Documentation quality is the bottleneck.

CMS 0057 and FHIR-based workflows are reshaping how authorization requests move between providers and payers. But better pipes won't fix weak documentation; practices still need complete, guideline-ready submissions regardless of how they're transmitted.

Caldarium prepares evidence that meets the bar today, and as standards evolve. Human-in-the-loop by design, with transparent, audit-ready outputs your team can review and verify.

CMS-0057-F · COMPLIANCE DATE

January 2027

The clock is already running: payers must have electronic prior-auth rails live by then. Complete, guideline-ready documentation is what makes those rails worth using.

FHIR-AWARE CMS 0057 READINESS HUMAN-IN-THE-LOOP AUDIT-READY RECORDS

Who it's for

Built for the people who own the queue.

Authorization & patient access

You own the queue. You know which payers are impossible and which codes come back. You cannot hire fast enough to keep pace, and the people who know the rules keep leaving.

Revenue cycle

You carry the appeal cost and the write-offs. What you need is a number for how much of it was preventable paperwork rather than genuine medical necessity.

Built for single-specialty groups of ten or more physicians — orthopedics, gastroenterology, rheumatology, neurology, oncology, pain management.

FAQ

Questions practices ask us.

Do you replace our staff or clinicians?

No. Caldarium prepares the work: your staff review, approve, and submit every request. Clinical judgment stays with your team, and nothing goes to a payer without a human sign-off.

Which authorizations does Caldarium handle?

We start with infusion and specialty medications, where documentation burden and denial cost are highest, then extend to imaging, high-value procedures, and surgical authorizations.

What does the Prior Auth Diagnostic cost?

Nothing, and it carries no obligation. You get a written report of findings (where revenue is leaking and what to fix first) whether or not we work together.

How do you handle AI and trust?

Every output is transparent and reviewable: readiness checks link back to the exact chart evidence, and each request keeps an audit-ready record. AI does the reading; people make the decisions.

Are you live in practices yet?

We're working with a small group of early partner practices, starting in GI infusion. If you'd like to be one of them, the Diagnostic is the way in.

See where prior auth is costing you.

Start with a diagnostic, or grab 20 minutes with our founder.