AI-Powered Prior Auth in Minutes, Not Days.

Features

The Prior Auth Pipeline

• Smart Intake

  Search by patient name or claim number. Real-time 270/271 eligibility check shows plan details, copay, deductible, and whether PA is required — before you submit.

• 5-Agent Assessment

  AI pipeline: extract clinical data, match payer policy via RAG, pull per-criterion requirements, run gap analysis (MET/NOT MET/INSUFFICIENT), then synthesize.

• Criterion Review

  Each criterion shows evidence quotes from the chart, confidence scores, clinical rationale, and recommendations. Override any finding with a required written rationale.

• Sign & Submit

  Attestation-gated human sign-off with NPI identification. Preview the full PA packet before signing. Three decision paths: Approve, Pend, or Deny.

• Payer Tracking

  Fax submission with SLA countdown. Record payer responses manually (approved with auth number, denied with reason, pended with requested items). Status polling built in.

• Appeals

  Single-case and bulk appeal workflows. AI-drafted appeal letters with grounding gates, human approval, PDF packaging, and fax submission. FHIR write-back on outcome.

How It Works

Submit to Authorize

1. 01

   Submit the Claim

   Search by patient or claim number. Real-time eligibility check confirms PA is required. One click sends the case to the 5-agent AI pipeline.

2. 02

   AI Assesses

   Five agents extract clinical data, match payer policy, pull criteria, run gap analysis, and synthesize a recommendation. Average time: under 5 minutes.

3. 03

   Review & Transmit

   Override any criterion with a written rationale. Sign with attestation. Submit to payer via fax. Record the response and track through to authorization.