Prior authorization automation

Capability build, payer provider operations

In development: evidence gathering and policy cross-reference before submission. Clinical staff still approve every request.

The situation

Prior authorization remains one of healthcare's worst bottlenecks. Providers spend enormous administrative time compiling clinical documentation to justify a procedure or medication. A large share of initial submissions get denied on paperwork or missing-criteria grounds, not clinical merit. Every payer has different requirements, and staff manually cross-reference charts against policy for every request.

What we're building

A multi-agent pipeline adapted for clinical and compliance complexity: chart intake that structures notes, labs, and history from an EHR export; policy matching that checks documented criteria against the payer's published rules; gap flagging that surfaces what would close a hole before submission; submission drafting with clinical justification mapped to criteria and tied to chart evidence; and a denial-risk score so staff can strengthen documentation before it goes out. Human clinical staff review and approve every submission. The system accelerates evidence-gathering and cross-referencing, not clinical decision-making.

Intended impact

Intended impact: fewer initial denials on paperwork grounds, faster turnaround per request, less staff time per case, with the same evidence-traced, human-gated discipline as our recruiting systems. This is a capability build in progress, not a completed client engagement yet.

Tell us where the hours go.