Rhyme Pricing: What the Prior Authorization Network Costs

As an enterprise licence sized to authorization volume, on the evidence available. Rhyme has a payer product and a provider product and describes itself as uniting the two sides on one network, so it is reasonable to expect that payers pay for connectivity and automated decisioning on their side and providers pay for submission, status and EHR embedded workflow on theirs. Rhyme does not say which side subsidises which, and you should ask directly, because a network heavily funded by payers can afford lower provider fees and a network funded mainly by providers cannot.

Within a provider agreement, the levers are volume bands, the number of facilities or tax identifiers covered, EHR integration scope and whether Rhyme staff work exceptions. Some network vendors charge per completed authorization; others charge a platform fee with volume bands. Ask for both shapes on your volumes, and ask for the same table priced with and without your lowest volume payers, because network coverage of a payer you rarely use is worth less than the pitch implies.

Where your pain is internal process rather than payer connectivity, a network is the wrong shape regardless of price, and the prior authorization automation use case explains how to tell the two apart before you request a quote.

Included, on the vendor's description, is the network connection to participating payers, real time or near real time determination and decision where the payer supports it, status updates written back into the EHR, and coverage of all procedure types. Rhyme's site states 4 million plus authorizations delivered in the EHR each year, so the EHR embedded workflow is core rather than an add on.

What is likely to cost extra, and what to ask about, includes the following.

• EHR integration. Rhyme names no EHR systems publicly. Ask which systems have a production integration, what it costs to stand up, and what your EHR vendor charges on its side. Our Epic and Oracle Health pages list the integration routes a vendor should be able to name.
• Non connected payers. Requests to payers off the network still need to be submitted somehow. Ask whether Rhyme handles them by portal automation, fax or not at all, and what that costs.
• Exception handling. Whether a service team works pended and denied requests, and whether that is a separate fee.
• Attachments and clinical documentation. Whether clinical evidence moves through the network or still goes by portal upload.
• Implementation and training. Fixed price or time and materials.

The network value depends on your payer overlap, so get coverage of your top twenty payers by volume in writing before anything else.

The only published price in the category belongs to Availity, whose Essentials portal is free and whose Essentials Plus tier is a vendor stated 25 USD a month. Availity is also a network, but a clearinghouse network where staff still do the authorization work by hand; Rhyme sells the automation of that work. The comparison is therefore between paying nothing and doing the work, or paying an enterprise licence and removing most of it, and the answer depends entirely on your volume.

Waystar quotes an authorization module inside a wider revenue cycle platform, with third party reports of 100 to 300 USD per provider per month for small practices across the platform. For a health system already on Waystar, adding the module is usually cheaper than a second vendor; for one that is not, Rhyme's network approach and Waystar's platform approach should be quoted on the same authorization volumes. Latent Health is the specialty pharmacy alternative and does not overlap with Rhyme's procedural focus.

The prior authorization software comparison sets out which side of the transaction each vendor serves, which is the filter to apply before price.

It is worth it when authorization volume is high, payer overlap is high and the queue is procedural rather than pharmacy. A worked example. A health system submits 5,000 procedural authorizations a month. Staff spend an average of 20 minutes per request across determination, submission and status chasing, which is about 1,670 hours a month, or roughly ten full time equivalents at a loaded cost of around 4,800 USD each a month, so 48,000 USD a month.

If 70 percent of those requests go to connected payers and the network removes 80 percent of the handling time on those, the saving is about 935 hours a month, worth roughly 26,900 USD, before any gain from faster decisions and fewer administrative denials. That is the ceiling an annual licence should be tested against, and the two assumptions doing the work are the payer overlap and the time removed per request. Confirm the first in writing and measure the second in a pilot. The prior authorization cost calculator builds this with your own figures, and the denial rate benchmark tells you how much administrative denial reduction is actually available.

For an independent practice the arithmetic rarely works, because the volumes are too small for an enterprise licence and the portal you already have covers most of the ground.

• Named payer coverage. Your top twenty payers by authorization volume, each marked live, planned with a date, or not connected, as a schedule to the contract.
• A coverage remedy. A fee reduction or termination right if a named payer leaves the network or a planned connection misses its date.
• Pricing basis. Per completed authorization and platform fee options on the same volumes, with volume bands that move in both directions.
• Non connected payer handling defined and priced.
• EHR integration named, fixed price, with your EHR vendor's fee identified.
• Pilot measures. Minutes per request, days to decision and administrative denial rate, baselined for six weeks before and measured for six weeks after, with a purchase trigger agreed in advance.
• The business associate agreement and evidence. Rhyme has not published a BAA statement or named certifications on its main site. Request the agreement and the trust centre report together before any data moves, and check them against the HIPAA and AI compliance baseline.
• CMS-0057-F position. A written statement of how the network will use payer prior authorization APIs from January 2027, explained on our CMS prior authorization rule page, and what that does to your fee.

A network is only worth what your payer overlap makes it worth, and the vendor is the last party who should be calculating that for you. An independent review builds the payer volume table, checks it against the network's live coverage, models the saving with your minutes per request rather than a brochure percentage, and reads the coverage schedule and remedies before you sign. It also asks whether your existing clearinghouse or portal already reaches the payers that matter, which is the cheapest outcome and the one no vendor proposes.

Clunic takes no commissions or referral fees from Rhyme or any other vendor. Our vendor selection service runs the quote and pilot process on fixed terms, and the AI governance and compliance service covers the agreement and evidence review for vendors whose public compliance documentation is thin. Book a call if you have a Rhyme proposal and want the coverage schedule checked.