HEALTHCARE · AI AGENTS

    AI Agents for Prior Authorization

    From eligibility checks through appeals — AI agents that assemble clinical documentation, navigate payer-specific requirements, submit authorizations, and track every case to resolution. HIPAA-compliant with full audit trails.

    Automate your authorization workflow
    AI Agents for Prior Authorization hero

    The Administrative Burden of Prior Authorization

    Prior authorization is one of healthcare's most persistent operational bottlenecks. Every time a provider orders a procedure, medication, or referral that requires payer approval, a chain of administrative tasks begins: verify coverage, determine if authorization is needed, gather the right clinical documentation, fill out payer-specific forms (which differ by payer, by plan, by service type), submit through the correct channel, monitor status, and respond to requests for additional information. Multiply this by hundreds of authorization requests per week and you have a process that consumes enormous clinical staff time — time that should be spent on patient care. The documentation gathering alone can take hours per case, often requiring information pulled from multiple systems that don't share data. And when authorizations are denied — which happens often — the appeals process begins another cycle of documentation assembly, letter writing, and follow-up that can extend delays by weeks.

    12+ hours

    of staff time consumed per physician per week

    93%

    of physicians report care delays due to prior auth

    $166B

    in annual healthcare administrative costs across U.S. hospitals

    89%

    of physicians say prior auth contributes to burnout

    How AI Agents Transform Prior Authorization

    We build a system of specialized agents that handle the full authorization lifecycle — from determining whether authorization is needed through submission, monitoring, and appeals. Each agent is configured for your specific payer mix, specialty requirements, and EHR environment.

    Prior Authorization Pipeline

    AI Agent Orchestration Layer

    HIPAA Compliant
    escalationresubmissionstatus alertsAuthorization OrchestratorRouting · State Management · Payer Rules · Deadline TrackingEligibility AgentCoverage & Determination1Clinical DocumentationAgentEHR Extraction & Assembly2Submission AgentRouting & Confirmation3Monitoring AgentTracking & Follow-Up4Appeals AgentDenial Management5Physician Review · Clinical OversightCare Team · Patient Coordination
    Click an agent for details

    What Changes When Agents Handle Prior Auth

    Approval Speed

    Authorization decisions returned in hours instead of days or weeks. Some organizations achieving 89% immediate approval rates.

    Staff Time

    12+ hours per physician per week returned to clinical activities. Administrative staff reallocated from paperwork to patient-facing work.

    Denial Rates

    Consistent, rule-based validation and complete documentation reduce preventable denials. Appeal success rates improve through comprehensive, well-structured submissions.

    Compliance

    99% SOP compliance rate. Every submission, follow-up, and decision documented with a complete audit trail.

    Patient Experience

    Faster authorizations mean faster access to care. Patients aren't left waiting for treatment while paperwork moves between systems.

    Built for Your Clinical Operation

    EHR integration — Agents connect to Epic, Oracle/Cerner, and other major EHR platforms through secure APIs. They pull clinical data directly from the source — no manual extraction, no copy-paste.

    Payer-specific configuration — Every payer has different forms, different requirements, different submission channels. Agents are configured for your specific payer mix and adapt as payer rules change.

    Specialty awareness — Prior auth requirements vary dramatically by specialty. Agents are configured for your specific service lines — orthopedics, radiology, oncology, behavioral health, and more.

    HIPAA-compliant architecture — Role-based access, encryption in transit and at rest, audit trails on every action, PHI minimization. Built for healthcare from the ground up, not retrofitted.

    Human-in-the-loop for clinical judgment — Agents handle the administrative workflow. Clinical decisions that require physician judgment are surfaced with full context so clinicians can act quickly.

    Automate Your Authorization Workflow

    Show us your current prior authorization process — the payers, the specialties, the volume, the bottlenecks. We'll map out where agents can eliminate manual work and what the time savings look like for your specific operation.

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