Prior Authorization Automation — Eliminate the Bottleneck
Your staff spends 13+ hours per week on prior authorizations. Most of that work is repetitive, rule-based, and perfectly suited for automation. We build the workflows that eliminate it.
Prior authorization is the single biggest administrative burden in healthcare — and the #1 cause of delayed patient care. The process hasn't changed in 20 years, but the technology to automate it has.
The Prior Authorization Problem
Every healthcare organization knows the pain. A provider orders a test, procedure, or medication. Before it can happen, someone on your staff has to:
13 hrs
Staff time per week on prior auth (AMA, 2024)
34%
of prior auths are initially denied (MGMA)
$11
Average cost per manual prior auth submission
What We Automate
We build end-to-end prior authorization workflows that handle the entire process — from the moment an order is placed to the moment the authorization is approved. Here's what the automated workflow looks like:
1. Auto Document Assembly
When a provider places an order, the automation pulls the required clinical documentation from your EHR — diagnosis codes, clinical notes, lab results, imaging reports — and assembles it into the payer-required format. No manual chart review. No copy-pasting between screens.
2. Payer Rule Engine
Each payer has different rules for what requires prior auth, what documentation they want, and how they want it submitted. We build a payer-specific rule engine that checks authorization requirements in real-time and routes each request to the correct workflow.
3. Automated Submission
Requests are submitted electronically via payer portals, APIs, or electronic attachment standards (X12 278). For payers that still require fax or phone, the system queues those requests with pre-populated forms and staff instructions.
4. Status Tracking & Follow-Up
The system monitors every pending authorization — checking payer portals automatically, logging status changes, and escalating requests that are taking too long. Your team sees a real-time dashboard of all pending, approved, and denied authorizations.
5. Exception Alerts & Escalation
When a request is denied, delayed, or needs peer-to-peer review, the system immediately alerts the right person — with a briefing packet that includes the denial reason, the relevant clinical documentation, and suggested next steps.
6. Denial Management
For denials, the system auto-generates appeal letters using clinical documentation and payer-specific appeal requirements. It tracks appeal deadlines, manages resubmissions, and gives your team a clear view of denial patterns by payer, procedure, and reason.
Results Healthcare Organizations See
60-80%
Reduction in Staff Time
Staff that used to spend 13+ hours/week on prior auth now spend 2-4 hours handling exceptions only.
30-50%
Faster Turnaround
Authorizations that took 5-7 days now complete in 2-3 days. Urgent requests process same-day.
15-25%
Fewer Denials
Complete, accurate submissions with the right documentation reduce initial denial rates significantly.
3-6 mo
Payback Period
For organizations processing 200+ prior auths/month, the automation pays for itself within one to two quarters.
How We Implement Prior Auth Automation
We don't sell software. We build and manage the automation for you.
Free Assessment
1 weekWe map your current prior auth workflow — volume by payer, denial rates, staff time, pain points. You get a clear picture of the opportunity.
AI Roadmap
2 weeksWe design the automated workflow, specify EHR integrations, and build the payer rule engine. Includes $50K savings guarantee.
Build
4-8 weeksOur engineers build the automation — EHR integration, payer portal connections, rule engine, dashboards, and alerts. HIPAA-compliant from day one.
Run
OngoingWe manage the automation for you — monitoring performance, updating payer rules, handling exceptions, and optimizing continuously. $2K-$5K/month.
Why Not Just Buy Prior Auth Software?
There are prior authorization software products on the market — CoverMyMeds, Infinitus, Olive AI (now shut down), and others. Here's what we've seen:
One-size-fits-all doesn't fit healthcare.
Every organization has different EHRs, payer mixes, specialty workflows, and exception handling needs. Software products force you into their workflow. We build around yours.
Integration is the hard part.
Prior auth automation is only as good as its EHR integration. Off-the-shelf products often have shallow integrations that still require manual data entry. We build deep, bidirectional integrations.
Payer rules change constantly.
Payers update their prior auth requirements regularly. Software products update on their schedule. We update your rule engine within days of a payer change.
You need a team, not a tool.
Prior auth automation isn't a set-it-and-forget-it solution. It needs ongoing monitoring, rule updates, and optimization. That's what our managed service provides.
Ready to Automate Prior Authorization?
Start with a free assessment. We'll analyze your prior auth volume, denial rates, and staff time — and show you exactly what automation can save.
- Free workflow assessment — see your savings potential
- Works with Epic, Cerner, athenahealth, and all major EHRs
- HIPAA-compliant, fully managed
- $50K savings guarantee on AI Roadmap
Frequently Asked Questions
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