OT Prior-Auth and Denial Cost Calculator
See what prior-auth denials are costing your occupational therapy practice each month, and how much a Relay AI employee could recover by handling the auth paperwork before claims go out. Every figure comes from your own numbers. The only external benchmark is the HFMA standard: a denial rate under 5% is optimal, and the industry average runs 5-10%.
Revenue lost to denials per month
$7,280
Recoverable revenue per month
$2,730
The share above the HFMA under-5% benchmark. Shows $0 if you are already at or below 5%.
Staff hours freed per month
21 hours
Relay's working assumption that automation removes roughly 60% of authorization time.
Revenue lost per year if nothing changes
$87,360
OT billing uses CPT codes 97165, 97166, 97167, and 97168 for evaluations and 97110 (therapeutic exercise) and 97530 (therapeutic activities) for treatment. Treatment codes are timed 15-minute units per AMA CPT guidelines, so a single visit commonly generates multiple billable units. This calculator works at the visit level; your actual per-visit revenue will reflect your typical unit mix.
All figures are calculated from the numbers you enter. Relay does not source or endorse any specific reimbursement rate. The only external benchmark used here is HFMA: a denial rate under 5% is considered optimal, with the industry average between 5% and 10%. The recoverable revenue figure is the gap between your current denial rate and the 5% floor; it clamps to $0 if your rate is already at or below 5%.
Common questions.
What counts as a billable OT visit for this calculator?
Any patient encounter you bill to a payer, whether an evaluation (97165-97168) or a treatment session (97110, 97530). Enter your actual monthly volume of those billed encounters.
Why does recoverable revenue go to $0 when my denial rate is 5% or below?
HFMA sets 5% as the optimal denial rate threshold. Below that floor, denials are largely unavoidable administrative noise. The recoverable figure measures only the gap above that floor, so there is nothing to recover when you are already at the benchmark.
What does the 60% hours-freed figure mean?
It is Relay's working assumption, not an industry statistic. It reflects the share of prior-auth staff time that AI employees typically absorb in Relay deployments. Your actual result will depend on your current workflow.
How do AI employees reduce OT prior-auth denials?
Relay builds AI employees that work inside your existing systems. They check payer-specific auth requirements before a visit is scheduled, flag missing documentation early, and track pending authorizations so nothing slips through. A human staff member reviews and finalizes. Less manual handling means fewer submission errors and fewer denials.
Are the default values real reimbursement rates?
No. The defaults are round, editable placeholders to get you started. Enter your clinic's actual visit volume, collected revenue per visit, and denial rate for figures that reflect your practice.
See where this is leaking in your clinic
The calculator shows the gap. The free 30-minute intro call shows you which workflow an AI employee would close first.