Prior authorizations, finally on autopilot.
The AI Prior Auth Agent submits, tracks, and follows up on prior authorization requests across payer portals, fax workflows, and electronic channels — without keeping a human on hold.
Why this gets built next.
Prior auth is the most expensive administrative task in healthcare. It's also the most automatable — if you can navigate every payer portal, fax line, and phone tree.
Capabilities, end to end.
Determines which services require PA by payer and plan
Auto-assembles clinical packets from EHR data
Submits via payer portals, EDI 278, fax, or phone (where supported)
Tracks status and escalates stalled requests
Notifies staff and providers when action is required
From signal to action in under a minute.
Ingest
Reads from your EHR, PM, clearinghouse, or payer feed. Zero rip-and-replace.
Reason
The agent applies RCM-trained logic, payer rules, and confidence scoring.
Act
Submits, escalates, or hands off to a human — with full audit trail.
Outcomes our customers measure.
reduction in staff time spent on PA
not days — faster approval turnaround
canceled procedures from missing authorization
Questions, answered.
Can it submit via fax and phone?
Yes. The agent uses both digital channels (portals, EDI 278) and voice/fax where payers require them.
How does it know what requires PA?
A continuously updated payer rule engine. We monitor payer policy bulletins and update rules within hours.
What happens if the agent can't get an approval?
It escalates with a full activity log, the payer response, and recommended next steps for staff or provider.
See AI Prior Auth Agent in action.
Book a 30-minute demo built around your payer mix and specialty.
HIPAA · SOC 2 Type II · BAA included