AI Assistant for Prior Auth Submissions
- Automated ePA Submissions
- Policy-Aware Intelligence
- EHR-Native Workflow
- Real-Time Status Tracking
Prior Authorization Is a Costly Bottleneck in Provider Operations
From the provider side, obtaining prior authorizations is a notorious administrative burden. Physicians and their staff complete about 39 PA requests per physician per week, consuming nearly 13 hours of work time weekly (ama-assn.org).
Many practices even employ staff solely dedicated to handling PAs (40% of physicians report having such staff). This not only costs practices time and money, but delays in PA approvals often postpone patient care and can lead to patients abandoning treatment.
Administrative Time Drain
- Physicians average 39 PA requests per week
- Nearly 13 hours of staff time lost weekly
- Clinical teams pulled away from patient care
High Operational Cost
- 40% of practices employ PA-dedicated staff
- Manual workflows increase overhead and burnout
- Rising administrative costs without added value
Fragmented, Manual Processes
- Multiple payer portals and inconsistent requirements
- Repetitive data entry across systems
- Limited automation or interoperability
Delays That Impact Patient Care
- Slow approvals postpone treatment initiation
- Increased likelihood of therapy abandonment
- Reduced patient satisfaction and outcomes
Operations-Facing Automation for Providers
Operations-Facing by Design
Purpose-built for provider administrative teams and clinicians, this solution automates the most time-consuming aspects of prior authorization. By handling data gathering, form completion, and submission workflows behind the scenes, it reduces manual effort, minimizes errors, and allows staff to focus on higher-value clinical and operational work.
Operational Efficiency That Improves Patient Access
Streamlining back-office prior authorization processes leads directly to faster payer responses and fewer delays in care. While designed for operational teams, the impact extends to patients—shortening time to treatment, reducing abandonment due to delays, and improving the overall care experience without increasing clinician workload.
AI-Powered One-Click Prior Authorization
The agent can also proactively check medical policy criteria – flagging if documentation is missing or if the request is likely to meet criteria – so that denials are reduced. It can then monitor the status of the auth and alert clinicians when a decision is made. This turns a typically tedious, multi-step process into an assisted one-click task for providers.
FHIR-Native, CMS-Ready Prior Authorization Interoperability
Critically, the solution aligns with the forthcoming CMS mandate for PA interoperability by 2026. It would use FHIR-based PA submission (for example, HL7 Da Vinci Coverage Requirements Discovery and Prior Authorization Support implementation guides) to send structured requests to payers and receive responses electronically.
It also pulls clinical data via FHIR from the EHR to support the request (e.g. assembling a FHIR Bundle of supporting info).
