Case Study: Cass Medical Center Slashes Prior Authorization Denials and Recovers Revenue

Prior Authorization Case Study

Background:

Cass Medical Center, a rural provider serving a diverse patient population, was facing a growing challenge in its outpatient clinics: inefficiencies in prior authorization. The internal team faced mounting administrative workloads, inconsistent payer requirements, and delays that often led to claim denials and care disruption.

During the first quarter of 2024, these challenges became particularly costly. Across the clinics NYX Health would later support, Cass Medical Center experienced 96 denials tied to prior authorization issues, totaling $347,778 in denied revenue. The process was slow, manual, and prone to errors, placing a strain on both operational staff and clinical workflows.

The Problem:

Prior authorizations were becoming a bottleneck to both care delivery and financial performance. Each denial represented lost revenue and, more critically, a delayed or disrupted patient experience. Clinical teams were pulled away from patient care to track down approvals, appeal denials, or restart the process altogether.

With payer requirements becoming more complex and staff already stretched thin, the leadership team at Cass Medical Center knew something had to change. They needed a partner that could bring efficiency, accuracy, and speed to their prior authorization processes, without requiring a large internal overhaul.

The NYX Health Solution:

In late 2024, Cass Medical Center partnered with NYX Health to manage and optimize the prior authorization process for its outpatient clinics. NYX Health deployed a dedicated team of specialists supported by intelligent automation tools to ensure faster submissions, better documentation, and full transparency.

Key elements of the NYX Health approach included:

  • A centralized and standardized submission process
  • Proprietary technology to enable auto-approvals where possible
  • Dedicated prior auth experts managing payer follow-up and escalation
  • Transparent reporting and weekly meetings to track performance

Results: Measurable Improvements in Just One Quarter

Within the first quarter of implementation (Q1 2025), the transformation was significant. Compared to the same period the year before:

  • Denied cases were cut in half, dropping from 96 to 47
  • Denied dollars fell by over $126,000, from $347,778 to $221,357
  • Overall approval rating soared to 97%
  • 13.9% of approvals were auto-approved through NXY’s pre-certification automation
  • The average turnaround time to receive an approval dropped to just 2.5 days
  • Total FTE Savings – 30%

These improvements directly translated into faster access to care for patients, less administrative burden for providers, and stronger financial outcomes for the organization.

The Impact:

By partnering with NYX Health, Cass Medical Center regained control of its prior authorization process. Clinical teams could refocus on patient care, leadership had better visibility into authorization metrics, and the revenue cycle team saw a dramatic drop in preventable denials.

“We knew we needed a change, but we didn’t expect to see results this quickly. NYX Health helped us cut denials in half and gave our teams the breathing room to focus on what matters—patient care.”
             — Revenue Cycle Director, Cass Medical Center

NYX Health not only reduced denials and improved cash flow but did so with a model that required minimal internal disruption. The success at Cass Medical Center highlights the value of combining expert support with smart technology to address one of healthcare’s most persistent challenges.

Conclusion:

Cass Medical Center’s experience is a testament to what’s possible when healthcare organizations reimagine prior authorization as a strategic priority. With NYX Health, they turned a high-cost operational headache into a streamlined, high-performing process—one that delivers better outcomes for both patients and the bottom line.

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