Prior-Authorization Support Desk

A service desk that handles prior-approval paperwork for EU specialty clinics can work, but only if you sell it as getting revenue back and staying compliant, not as software.

There's a real backlog in prior authorization, meaning getting the payer to approve treatment before it happens, plus other pre-treatment approvals. It's painful, deadline-driven, and costs real money to administer. That's from US data, but it points in a useful direction for an EU service.

The best way in is a packaged desk for private clinics and specialist practices. It takes in the case, fills out the forms, submits to the payer, tracks deadlines, and handles appeals in the patient's language. But be clear: this runs like an operations company with some software behind it, not a clean software-as-a-service product.

The real question is whether you can cluster enough private-pay and cross-border cases to keep the desk busy once compliance work eats into your time. The model runs on deadlines and needs a lot of people.

• US practices do about 39–45 prior authorizations per physician per week (US reference data).
• Prior authorization costs US practices about €32.2B a year to administer (converted from a US-sourced $35B estimate) (US reference figure; no published EU equivalent).
• The regulatory timing helps in the EU: France has its demande d’entente préalable pre-approval queue and Germany has PKV pre-treatment coverage queries. On top of that, cheap AI tools now let one person run this.
• Compliance is a real hurdle. GDPR Article 28 data-processing agreements and German Section 203 StGB mean you need better tooling and insurance before you can operate.
• There's already a market price for this kind of outsourced work: some charge per case, some monthly, some a cut of volume.