auto_submit · 94% confidence
Pulmonology · BCBS TX
Referral #RC-2847 re-sent
72h SLA · specialist notified
BCBS TX · $2,400
Sleep study · auth #TX-994821
UHC Medicare Advantage now requires referrals for all independent PCPs. CMS-0057-F mandates FHIR Prior Auth APIs by January 2027.
33%
of referrals never reach the specialist
80%
of PA denials preventable with docs
90s
to submit a complete PAIA-reviewed referral
168d
until CMS-0057-F FHIR mandate deadline
Built for every part of the referral chain
Independent Practices
1–5 providers
Stop losing revenue to the referral black hole.
You built this practice. You shouldn't be losing $971K/yr because referrals disappear between providers. Plerous catches every one.
Built for independent PCPsPhysician Groups
6–25 providers
Scale your network. Not your admin burden.
Your coordinators should be caring for patients, not chasing specialists. Plerous automates the entire referral loop across your whole group.
Built for groupsHospitals, Imaging & Surgery Centers
Any size facility
Own every inbound referral from first contact to booked procedure.
Every incomplete referral packet is a procedure that doesn't happen. Plerous ensures inbound referrals arrive complete, authorized, and scheduled.
Built for facilitiesThe referral black hole
Your coordinator sends the referral.
She calls to confirm. No answer.
She calls again Tuesday. Voicemail.
By Thursday, nobody knows if the specialist received it.
The patient calls your front desk Friday, asking what happened.
Two hours of staff time later, you find out:the authorization was never submitted.
The appointment was never booked.
The revenue is gone.
This is happening right now — in 1 in 3 of your referrals.
Without Plerous
With Plerous
Works with every specialist you refer to — whether or not they use Plerous. We meet them on the rails they already use, so the loop closes from day one.
What's it costing you?
Enter your numbers. See yours. Based on MGMA 2022 benchmarks — your actual exposure depends on specialty, payer mix, and current workflow.
$1.0M
~576 referrals estimated incomplete/yr · Pulmonology / Sleep
Based on 60% industry leakage rate. Your practice rate may be higher or lower.
$311K – $571K
estimated range / year
Depends on staff adoption, payer mix, and workflow integration. Range reflects 30–55% completion improvement from published automation studies.
$1K/yr
Cost vs. risk
262–480×
estimated return range
⚠️ This is a rough planning estimate, not a revenue guarantee. Outcomes vary significantly by practice size, specialty, payer contracts, staff workflow adoption, and local market conditions. Consult with your practice manager before making financial decisions based on these figures.
Close the loop · Enter your NPIIntelligence at every hand-off
Before your coordinator hits submit, Plerous has already checked eligibility, scanned the clinical notes, matched the diagnosis codes, and flagged every documentation gap that payers use to deny claims. Four checks. Under 90 seconds. Every time. We call this engine .
Coverage check
Validates eligibility and whether prior auth is required for this CPT + payer combination.
Documentation scan
Reads clinical notes. Auto-extracts ESS scores, AHI values, STOP-BANG, and step therapy.
Diagnosis match
Verifies ICD-10 codes support the procedure. Catches mismatches payers use as instant denials.
Decision
Auto-submit at ≥85% confidence. Human window for flags. Hard stop on incomplete documentation.
Every analysis persisted with a SHA-256 audit chain.
Full HIPAA-compliant audit log. Every AI decision traceable. Every human override recorded.
10 agents. Every gap covered.
No per-seat SaaS tax. No integration overhead. Each agent closes a specific gap in your referral loop — with full context, autonomous action, and a complete audit trail.
Coordinator Brief
Morning summary — stalls, SLA alerts, priorities
Sentinel
24/7 monitor — auto-recovers every stalled referral
PAIA
4-check pre-auth intelligence before every submit
Recovery
Rescues referrals stuck in specialist acknowledgment
Revenue Recovery
Surfaces revenue leaking from unscheduled referrals
Scheduling
Closes the loop from auth approval to appointment
Prospect Intel
NPI-researches prospects before outreach
Relationships
Tracks referring relationship strength over time
Care Gap
Identifies patients with unaddressed care gaps
Founder Brief
Revenue, growth, and churn signals — daily
Everything to own the loop
Not a referral form. Not a portal. The full closed-loop infrastructure — from NPI onboarding to payer submission to denial appeal generation.
Enter your NPI. Plerous pulls your name, specialty, address, phone, fax, and license from CMS NPPES automatically. Creates your org, provider record, and account in one transaction.
Epic, Cerner, Tebra, DrChrono, eCW, Elation, ModMed, NextGen, PracticeFusion, athenahealth. SMART on FHIR OAuth with PKCE.
Runs every 15 minutes. Alerts on stale drafts, unresolved PAIA flags, expiring auths, and stuck prior auth submissions. Auto-recovers.
When a payer denies, Plerous generates a clinical appeal letter using the referral's diagnosis codes, clinical notes, and denial reason. PAIA's denial model updates in real time from every outcome.
Policy rules backed by real denial data. Edit at runtime. Cache refreshes instantly. PAIA learns from every outcome.
Every AI decision, human override, and admin action logged with before/after state, actor, IP, and timestamp.
Pricing as clean as the loop we close.
Flat-rate for practices. Usage-based for EHR partners. No per-referral fees. Ever.
Starter
Built for independent PCPs with 1–5 providers. Everything to survive the UHC mandate.
Professional
6–25 providers. Multi-location groups, multi-specialty practices, growing independent networks.
Enterprise / API
Unlimited providers. EHR white-label. For Tebra, DrChrono, eCW, and regional health systems.
The clock is running
UHC is already requiring referrals for Medicare Advantage PCPs. CMS-0057-F follows in January 2027. Independent practices not on FHIR-native infrastructure will face denial rates they can't survive.
Close the loop for your practiceFree to start · HIPAA compliant · No IT required
Every referral. Every authorization.
Every patient. Closed.
Plerous closes the loop.
Enterprise & payer partnerships
Building a white-label integration? Evaluating Plerous for your health system or payer network? We work directly with EHR vendors, regional health systems, and payer partners.
hello@plerous.comWe respond within one business day.