AI for Medicare DME prior authorization

AI that gets your DME prior auths affirmed the first time.

AffirmDME's AI reads your documentation, checks it against Medicare's requirements item by item, shows what's missing — with the citation — before you submit, and drafts your ADR (Additional Documentation Request) responses. So you stop reworking denials.

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Built for Medicare DME suppliers · Noridian & CGS · No credit card — explore free in sandbox mode, pay per case

Denials are expensive. Most are avoidable.

Prior auth means chasing chart notes, re-keying orders, and hoping nothing's missing. When something is, the claim comes back — and reworking a single denial costs about $118. Multiply that across your monthly volume.

24 min
of staff time per manual prior auth (CAQH Index, 2024)
~$118
to rework one denied claim (Change Healthcare Revenue Cycle Index, 2017)
$75
a case on AffirmDME, pay-as-you-go — less than one denial. As low as about $15 a case on a per-location plan.

From documents to a clean submission — in four steps.

1

Create the case

Enter the patient, prescriber, and items — we handle the Medicare MAC routing.

2

Upload documents

Drop in chart notes, the order, test results. AffirmDME reads them automatically.

3

Review readiness

See a per-item checklist of what Medicare requires and exactly what's still missing.

4

Submit with confidence

Send a clean packet. If an ADR comes back, AffirmDME drafts your response.

Try it risk-free — no PHI required.

Sign up free and switch on sandbox mode to explore AffirmDME with realistic sample cases. See the AI readiness checks, document extraction, and the full workflow end to end — without entering any real patient data. When you're ready, run your first real case.

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See it in action.

Know exactly what's missing

AffirmDME checks every document against Medicare requirements and flags the gaps — with the regulatory citation — before you submit. Not on the PA list? The same checklist makes oxygen, CPAP, and hospital-bed claims audit-ready before an ADR arrives, and drafts the response if one does.

Case readiness checklist

Track every case, intake to decision

A live view of readiness and status across your team — so nothing stalls and nothing slips.

Cases list

See your numbers

Affirmation rate, volume, and what's stuck — at a glance.

Dashboard

Everything a DME prior-auth workflow needs.

AI document extraction

Reads chart notes, orders, and results — no manual re-keying.

Readiness checklist

Per-item Medicare requirements — catches gaps before submission, not after a denial.

Prescriber outreach

Fax documentation requests and track responses.

E-signature (SWO)

Send the Standard Written Order for signature via DocuSign.

Submission packet

One click assembles the signed order, clinical docs, and checklist into a submission-ready packet.

ADR response drafting Pro

AI drafts your Additional Documentation Request response.

Compliance dashboard

Affirmation rate, exemption tracking, audit trail.

Multi-location

Per-location PTAN/NPI, billing, and reporting.

Purpose-built for Medicare DME — not a generic doc tool.

It knows the rules

Checklists map to real Medicare requirements (LCD/NCD, 42 CFR, CMS PA checklists) for the DME MACs — not a generic "summarize this PDF."

It catches gaps before you submit

The value isn't reading a document — it's telling you what's missing while you can still fix it, not after a denial.

It fits your workflow

Upload what you already collect. No new system to learn, no change to how your team works.

It pays for itself on the first avoided denial.

At $75 a case, AffirmDME costs less than reworking one denial. See what denials cost you today:

$—
in denial rework, every month
AffirmDME reviews every case for $75 and flags what's missing before you submit — so fewer of these become denials.

Built for HIPAA from day one.

AffirmDME runs on HIPAA-eligible AWS services under a Business Associate Agreement, and a BAA is available for your practice. Document AI runs inside AWS (Amazon Bedrock) — your data isn't used to train models or shared with third parties.

  • Encryption in transit and at rest
  • Full activity audit log
  • Role-based access control
  • Subprocessor transparency
  • BAA available
  • Data stays within AWS

Simple, transparent pricing. Get started.

Pay $75 per case while you're getting started. Per-location plans bring that to as low as about $15 a case at volume — we show you when the switch pays.

Pay-as-you-go
$0
base
  • No subscription
  • $75 per case
  • 5 e-signatures per month included
  • Best while you're getting started
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Starter
$1,500
per location, per month
  • 50 cases per location included
  • $35 per case overage
  • 10 e-signatures per location included
  • Up to 2 locations
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Professional Most popular
$2,200
per location, per month
  • 150 cases per location included
  • $20 per case overage
  • 30 e-signatures per location included
  • Exemption dashboard, ADR drafting
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Enterprise
Custom
  • Volume pricing
  • Onboarding & support
  • SSO, API access
Contact us

Overages billed per location on your next invoice. Extra e-signature envelopes $10 each.

Questions, answered.

Is AffirmDME HIPAA compliant?

We run on HIPAA-eligible AWS services under a Business Associate Agreement, with encryption in transit and at rest and a full audit log. A BAA is available for your practice.

How does pricing work?

Get started at $75 per case with no subscription. Per-location plans bring that to as low as about $15 a case at volume: Starter is $1,500 a month per location with 50 cases included, Professional $2,200 with 150. The app shows you when a plan would have been cheaper.

Which payers do you support?

Medicare DME prior authorization through the DME MACs (Noridian and CGS).

How accurate is the AI?

AffirmDME extracts and checks documentation against Medicare requirements and surfaces what's missing — you review and approve every case before submission.

Do I have to change my workflow?

No. Create a case, upload what you already collect, and submit. AffirmDME fits around how you work today.

Is my data secure?

Your documents stay within AWS. Document AI runs in Amazon Bedrock and your data isn't used to train models or shared with third parties.

Talk to us.

Questions or Enterprise pricing — a person replies within one business day.

Get an email when the Required PA List changes.

CMS adds codes, the DME MACs revise LCDs, cycle deadlines arrive. We send a short note the week it happens, with what to do about it. No drip campaign. Unsubscribe in one click.

Stop reworking denials.

Get started — your first case takes minutes.

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