MEDICAL PRIOR AUTHORIZATION SERVICE BUSINESS PLAN

I. Executive Summary

Company Description

The company is named MedAuth Bridge; the name signals a practical link between clinical teams and payers. We operate in the healthcare technology and revenue cycle management sector, providing an end-to-end prior authorization service for U.S. medical practices. Our core offering pairs a proprietary, HIPAA-compliant software platform with a team of licensed clinical authorization specialists who manage prior authorizations from intake through approval and appeal. We sell a recurring, tiered subscription that gives clinics predictable costs, configurable service SLAs, and real-time authorization dashboards. One-liner: MedAuth Bridge turns prior authorizations from a bottleneck into a predictable workflow.

Day-to-day we ingest orders, verify benefits, submit payer-specific requests, track status, handle appeals, and feed authorizations back into clinics’ EHRs and billing systems. We’ll launch in 2026 with headquarters in a major U.S. medical hub to recruit clinical and payer-experience talent. Target customers are small-to-mid sized primary care and specialty clinics that perform medium-to-high prior authorization volumes. Short-term goals: complete pilot Q2 2026, onboard 50 clinics by year-end, and achieve monthly recurring revenue targets. Long-term goals: scale nationally, serve 1,500+ clinics by 2030, and sustain >20% EBITDA through automation and tiered service expansion.

Problem

Manual prior authorization workflows consume clinical staff time, are error-prone, and lack transparency, pulling providers away from patient care and reducing clinic capacity for direct services.

These workflows cause revenue delays, higher denial rates, and impaired cash-flow visibility for independent practices; complex specialty medication and procedure approvals often require clinical expertise that current tools and payer processes do not provide.

Existing solutions are fragmented and insufficient: point tools and manual workarounds fail to deliver end-to-end visibility, specialty clinical input, or predictable operational capacity—creating a clear need for a scalable, HIPAA-compliant, team-plus-software service that restores staff productivity, accelerates approvals, and protects clinic revenue and patient access to care.

Solution

We offer a comprehensive, tech-enabled management service for the entire prior authorization lifecycle that integrates with provider workflows, automates data collection and payer submission, and pairs a dedicated team of prior authorization specialists with a HIPAA-compliant platform. This reduces the manual paperwork, burnout, and claim denials that keep clinicians from patient care.

Result: fewer administrative delays and clearer visibility for providers through real-time dashboard tracking, managed appeals and peer-to-peer reviews, and shifted administrative burden away from clinical teams.

Mission Statement

Our mission is to liberate healthcare providers from the administrative complexities of insurance authorizations so they can focus on delivering exceptional patient care. We commit to being the most trusted partner in the revenue cycle by offering transparent, expert-led, and technology-driven solutions that improve medical practices’ financial health and accelerate patient access to necessary treatments. We aim to set the industry standard for authorization approval rates and turnaround times across the United States through relentless innovation and clinical excellence.

Key Success Factors

Execution hinges on timely delivery, cost control, team scale, approval quality, and referral pipeline.

• Deliver the $120,000 EHR integration software and deploy by mid-2026.
• Maintain high authorization approval rate via expert specialist team for retention and reputation.
• Manage CAC from $2,400 to $1,800 to protect unit economics and path to profitability.
• Scale specialists 3→25 FTEs while preserving service quality to support $9.56M revenue target.
• Establish RCM referral partnerships to provide steady client pipeline and lower marketing risk.

Financial Summary

This Financial Summary highlights key revenue, profitability, and return metrics for the Medical Prior Authorization Service.

The business requires a minimum cash balance of $519,000, reaches break-even in Jul‑26, and delivers a total payback in 20 months; the model produces an IRR of 8.52% and ROE of 9.71%.

Financial outlook: revenue scales from $1.287M in 2026 to $9.565M by Year 5 with EBITDA positive and growing.

Funding Requirements

We seek a $519,000 seed injection to launch in 2026 and reach break-even in Jul-26.

Projected Year 1 revenue $1,287,000, Year 5 $9,565,000; break-even Jul-26; 20-month payback; EBITDA Year 1 -$11,000 to Year 5 $4,314,000; IRR 8.52% and ROE 9.71%.