Prior Auth Paperwork Is a Revenue-Killing Time Sink
Staff spend 2+ hours per prior authorization hunting through EHRs for diagnosis codes, medication histories, and clinical notes. Insurance companies require different forms for each drug/procedure, and missing documentation causes denials. Practices submit 40-80 prior auths weekly, costing $25-40K annually in staff time. Delayed approvals postpone treatments and frustrate patients.
Prior Auth on Autopilot
AI system that integrates with your EHR, reads prior auth requirements from payer forms, extracts needed clinical data (diagnosis, labs, failed therapies), auto-fills forms, attaches supporting documentation, and tracks approval status--reducing 2 hours to 10 minutes.
Integrates with Epic, Cerner, Athenahealth via FHIR
Identifies required prior auth based on medication/procedure
Extracts clinical data from EHR: diagnosis, labs, previous treatments
Auto-fills payer-specific forms (Optum, UHC, Cigna, etc.)
Attaches required documentation: clinical notes, lab results, imaging
Tracks submission and follows up on pending auths
From Order to Approval Tracking
Detect PA Need
When provider orders med/procedure requiring PA, system detects via formulary database and EHR integration.
Extract EHR Data
AI pulls diagnosis codes, medication history, lab results, and clinical notes from EHR via FHIR API.
Fill Forms
System auto-fills payer-specific prior auth form with extracted data. Attaches supporting documentation PDFs.
Submit & Track
Submits via payer portal or fax. Tracks status and alerts staff when approved or denied.
Key Features
Payer Form Library
Pre-loaded forms for 100+ payers and 500+ medications/procedures. Auto-updates when forms change.
Clinical Data Extraction
AI reads EHR notes and extracts relevant clinical rationale. Handles unstructured physician notes.
Appeal Generation
If denied, AI generates appeal letter with clinical guidelines and peer-reviewed evidence.
Status Dashboard
Visual dashboard shows all pending PAs, approval rates by payer, and average turnaround time.
Prior Auth Automation Stack
Who Benefits?
Specialty Pharmacies
Handle high-volume PAs for specialty medications. Reduce turnaround time from 5 days to 1 day.
Oncology Practices
Expedite chemotherapy and imaging approvals. Ensure patients start treatment on time.
Pain Management Clinics
Navigate complex opioid PA requirements. Reduce staff burnout from repetitive paperwork.