Solutions / AI Powered Healthcare Solutions / AI Prior Authorization Assistant
AI Powered Healthcare Solutions
Prior authorization without the hold music
Cuts prior authorization turnaround time and staff hours, reinforcing our 24 to 48 hour claim turnaround. The assistant prepares the request, submits it where the payer allows, and chases it until there is an answer.
Core capabilities
What it handles
Determining what needs authorization
Checked against payer rules for the specific procedure, so nothing is missed and nothing is requested unnecessarily.
Assembling the request
Clinical documentation, codes and medical necessity evidence pulled together into what that payer actually requires.
Submission
Through the payer portal or channel, with the format each one expects rather than a generic package.
Chasing for a decision
Followed up continuously until there is an answer, which is the part that consumes the most staff hours by far.
Expiry and visit count tracking
Authorizations tracked against remaining visits and expiry dates, with warnings before they run out.
Denial and appeal support
Denied authorizations flagged with the reason, and the appeal prepared for a person to review and send.
How it works
How it runs
Flag at scheduling
The requirement is identified when the appointment is booked, not when the claim is being built after the visit.
Prepare the request
Documentation assembled automatically, with gaps flagged to your clinical team while there is still time to fill them.
Submit and chase
Sent, then followed up relentlessly. This is where the staff hours normally go, and it runs in the background instead.
Track to expiry
The approval is recorded against the visit count and the expiry date, so it cannot quietly run out mid course.
What changes
Why this one matters most
Prior authorization is the work practices tell us they hate most, and the work that most often causes an avoidable denial.
Hours returned to your staff
Chasing payers is the single largest consumer of administrative time in most practices we assess.
Fewer authorization denials
Missing or expired authorization is one of the most common causes of denial, and almost entirely preventable with proper tracking.
Treatment is not delayed
Faster turnaround means patients get care when it was scheduled, rather than waiting on paperwork.
Human oversight
Where the person comes in
The assistant assembles and submits, but it never decides what care a patient needs. Medical necessity documentation comes from your clinicians, and a person reviews the request before it goes to the payer as well as any appeal that follows.
That boundary is deliberate and we hold it across every agent we run. AI prepares and flags. A trained person reviews and decides, and is accountable for the result.
- Clinical justification always comes from your clinicians
- A person reviews requests before submission
- Appeals are written and approved by a person
- Denials are flagged to you, never quietly accepted
Questions
Answers, straight
Does this work with all payers?
Where a payer offers a portal or electronic channel, the assistant uses it. Where a payer still requires a phone call, that part stays with a person, and we will be straight with you about which of your payers are which.
Who decides what to request?
Your clinicians decide what care is needed. The assistant handles getting the request prepared, submitted and chased.
What happens if it is denied?
You are told, with the reason, and an appeal is prepared for a person to review and send. Nothing is quietly written off.
Does it track how many visits are left?
Yes, and this matters most for therapy and rehabilitation practices, where authorizations run out mid course and cause denials nobody saw coming.
Practice Claim handles patient financial and clinical data under HIPAA-compliant processes. We do not claim certifications or accreditations the company does not hold.
Ready to see what you are leaving uncollected?
Book a free consultation. We will review a sample of your claims and show you where the revenue is going.