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Prior Authorization

Turn medical requests into authorization decisions.

You have Treatment request
You get Authorization decision

You pay Per authorization

  • Calls
  • Email
  • Documents
  • Portals
  • Follow-up
  • Appeals
Hire this Agent Start a Pilot

What you give it

  • Treatment request
  • Patient and payer information
  • Clinical documentation
  • EHR or intake access
  • Payer portal credentials
  • Appeal process rules
  • Clinical contacts for peer-to-peer

What it owns

  • Agent owns
  • Agent + human
  • Human decision
  1. Medical Request Agent owns
  2. Requirements Agent owns
  3. Documentation Agent owns
  4. Submission Agent owns
  5. Payer Follow-up Agent owns
  6. Additional Information Agent + human
  7. Appeal Agent + human
  8. Decision Human decision

What it can do

Communicate

  • Phone
  • Email
  • Payer portals

Work with information

  • Determine payer requirements
  • Gather documentation
  • Prepare submissions
  • Prepare appeals

Operate software

  • EHR
  • Payer websites
  • Internal applications
  • APIs

Coordinate

  • Check status
  • Respond to payer requests
  • Coordinate peer-to-peer review
  • Track outcome

You decide what the agent is allowed to do.

Action Permission
Determine payer requirements Allowed
Gather documentation Allowed
Submit authorizations Allowed
Respond to payer requests Allowed
Prepare appeals Allowed
Coordinate peer-to-peer review Allowed
Make a clinical determination Not allowed
Override medical policy Not allowed

Humans stay in the loop.

The agent owns execution. Your team handles judgment, authority, or escalation.

Agent handles 90% Example of execution
Exception detected The job pauses on a rule
Human decision Judgment, authority, or policy
Agent continues work Execution resumes after the decision

Run it against your operation.

Illustrative example
Your Team Agent
Work items 800 80
Completed 520 61
Conversion 65.0% 76.0%
Average cycle time 6.2d 2.8d
Cost per outcome $47 $22

Start with 10% of the work.

Measure the same outcomes you measure. Increase volume when the agent earns it.

Start a Pilot

Works with the systems you use.

The pilot should require little systems change.

  • API
  • Email
  • Spreadsheet
  • CRM
  • Browser
  • Shared Inbox
  • Database
  • File Upload
  • Internal Software
Hire this Agent