Prior authorization
Authorizationsthat finish themselves.
Requirements identified, clinicals bundled to policy, submitted through the right channel, and monitored until a decision arrives. People step in only when judgment is needed.
90%
Touchless authorization target
2 min
Average human review
1.2 s
Eligibility and requirement check
Requirements
Know if an authorization is needed the moment it is ordered.
Payer policies are digitized and matched to the order, plan, and site of service, so the answer is instant and the criteria are visible.
- Payer policy library kept current
- Requirement determination on order entry
- Criteria and documentation checklist surfaced to the team
- Check coverage270/271 · 0.8sCompleted
- Interpret benefitsAetna PPOCompleted
- Estimate responsibility$40 copay · 82% deductible metCompleted
Submission
Clinical bundling and submission, without a touch.
The platform finds the supporting documentation in the chart, assembles it to the payer's criteria, and submits via the channel the payer accepts.
- Documentation located and bundled from the EHR
- Submission via X12 278, payer portals, and fax
- Confidence scoring with human review below threshold
Ready to submit
Infliximab infusion · J1745
- Drug
- Infliximab, J1745
- Payer
- BCBS · Medical Policy 2.04
- Documents
- 2 notes, 1 lab panel
- Channel
- Payer portal · automated
Monitoring
Statused automatically until the decision arrives.
Pending requests are checked continuously, peer-to-peer requests are flagged immediately, and approvals are written back to the chart and the claim.
- Automated statusing across payers
- Post-authorization monitoring for changes in the order
- Approval details carried through to the claim
- Scrub claim 4471-04UHC · 837PCompleted
- Match auth on file#A82-114Completed
- 3CPT 27447 vs. auth 27446flagged pre-submitNeeds review
Ready to make authorizations disappear?
Pick your highest-volume service line. We will show you the touchless rate you can expect in the first ninety days.