PA-Call Ledger — prior-authorization rationale calibration for dental practice managers

PA-Call Ledger is a lightweight tool where the biller submitting a prior authorization writes a 2-3 line rationale (why this should approve: pre-auth status, frequency limits, medical necessity narrative, payer-policy version cited) at submission. The payer's PA decision, returning in 5-15 days, resolves each prediction. Manager sees calibration by biller × payer × procedure × rationale-pattern: which billers cite stale frequency rules, which payer-policy updates the team missed, which medical-necessity narratives systematically fail at which carriers. AE's adversarial autopsy grades the rationale prose (not just approve/deny) — surfacing premise-conclusion severing ("covered code" ≠ "covered for this patient this year"), cosmetic confidence ("usually approves"), and lifecycle-state drift (rule that promoted last quarter now demotes). Volume of 20-50 PAs/month per 5-30-person practice keeps double-entry tractable; one recovered PA covers a month at £300-£600/location.

PA-Call Ledger applies AE's rationale-grading and calibration infrastructure to a domain where reality grades itself in days, automation vendors target the wrong layer, and one recovered PA pays for the month.

Engine verdict: KILL (SKIP). Geography-confused, distribution-mismatched, transfer-learning-unverified product targeting a workflow regulators are explicitly automating away.