Prior Authorization Module

Accelerate Authorizations with AI-Powered Automation

Intelligent prior authorization with ML-powered routing, direct payer integration, AI voice agents, and automated appeal management. Streamline your authorization workflow.

Auto
Approval Workflow
AI-powered routing
6
Payer Connectors
direct integration
Real-time
Status Updates
EDI 278 support
AI
Appeal Letters
auto-generated
Status Tracking

Complete Authorization Lifecycle

Track every authorization through its complete journey with real-time status updates and automatic progression.

Draft
Pending
Submitted
Approved
Denied
Appeal
Core Capabilities

Enterprise Prior Authorization

Three-phase automation system designed for competitive parity with market leaders.

Smart Auto-Approval

ML-powered prediction engine analyzes requests and automatically routes approvals based on configurable rules and historical patterns.

Smartrouting logic
ML prediction
Configurable rules
Auto-routing
Gold card support

Direct Payer Integration

Real-time connections to major payers including UHC, Anthem, Aetna, Cigna, Humana, and Medicare for instant status updates.

6payer connectors
UHC
Anthem
Aetna
Cigna/Humana

Policy Intelligence AI

NLP-powered policy extraction analyzes payer requirements, matches clinical criteria, and identifies documentation gaps.

AIpolicy analysis
Policy extraction
Criteria matching
Gap analysis
Recommendations

AI Voice Agents

Intelligent voice agents handle routine payer calls, check status, and escalate complex issues to your team.

Autopayer calls
Status checks
Hold navigation
Call transcripts
Smart escalation
PA Workflow

Streamlined Authorization Process

AI-assisted workflow from request creation to final approval.

1

Request Created

PA initiated from order

2

AI Analysis

Policy & criteria matched

3

Submitted

Sent to payer

4

Approved

Authorization received

Advanced Features

Enterprise-Grade Capabilities

Built for healthcare organizations that demand the best in authorization management.

EDI 278 & FHIR PAS

Full support for electronic prior authorization standards including X12 278 transactions and FHIR Prior Auth Support.

X12 278 parsing
FHIR PAS ready
AAA error handling
Status mapping

Appeal Management

Comprehensive appeal workflow with AI-powered letter generation, deadline tracking, and outcome analytics.

AI letter generation
Deadline tracking
Document assembly
Outcome analytics

Gold Card Program

Track provider performance and identify gold card opportunities for expedited approvals with high-performing payers.

Provider scoring
Payer tracking
Auto-identification
Reporting
Differentiators

Why Choose Our PA Solution

Purpose-built for healthcare organizations that demand enterprise-grade PA management.

Real-time Status

Instant updates from payer portals and EDI

Clinical Criteria

InterQual/MCG guidelines integration

SLA Management

Track turnaround times and deadlines

Smart Notifications

Multi-channel alerts for status changes

PA Analytics

Approval rates, denial reasons, trends

Workflow Rules

Configurable routing and escalation

ROI Impact

Transform Your Authorization Process

  • Reduce authorization turnaround time significantly
  • Decrease denial rates with proactive documentation
  • Free up staff from manual payer calls
  • Improve patient care with faster approvals
  • Complete visibility into PA pipeline
AI
Accelerated
Intelligent authorization automation

Standards & Compliance

HIPAA Compliant
EDI 278 Certified
FHIR PAS Ready
Full Audit Trail
Multi-Tenant

Ready to Accelerate Authorizations?

See how our AI-powered prior authorization can transform your approval process. Schedule a personalized demo today.

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