Prior Authorization Agent
Payer-aware prior authorisation and appeals
Prior authorisation delays care by days, and staff cannot keep pace with each payer's changing criteria.
The agent gathers evidence from the chart, applies MCG or InterQual criteria with each payer's overlays, submits through the payer portal or X12 278, and appeals denials with a full clinical narrative.
- Evidence extraction from the chart
- Payer criteria tracked by version
- Submission by portal or X12 278
- Appeals drafted automatically
- Authorisation turnaround
- −71%
- First-pass approvals
- +38%
- Missed appeal windows
- 0
Works with Epic, Cerner, Availity, Change Healthcare, MCG, InterQual