READY-TO-DEPLOY AI AGENTS
Automate prior authorizations for payers with agentic AI
Comply with CMS timelines, cut operational costs, and improve provider relationships—all with full transparency and auditability.
Why prior authorization is breaking ops (and trust)
Regulatory pressure
New CMS timelines (7 days standard, 72 hours urgent) demand faster, documented decisions across all lines of business.
72 hours to comply with urgent requests under new CMS rules
Provider abrasion
Lengthy review cycles and opaque decisions damage provider relationships and member experience.
80% of providers report prior auth delays harm patient care
Rising admin costs
Manual review teams can’t scale to volume and compliance requirements—costs and backlogs keep growing.
2–3 hours of manual work per authorization on average
High‑impact automations for payers
This agent is pre-trained to run the entire authorization workflow. Deploy once on your systems, and it continuously processes incoming requests.
Case intake & triage
Auto‑ingest 278/attachments, normalize data, and route by line of business and urgency.
Cross‑check documentation against clinical guidelines; flag exceptions and assemble packets for human review.
Generate determinations with full rationale and send provider notifications with complete audit trails.
AI judges score accuracy and speed per run; export logs to support CMS/state reporting.
1) Intake & normalization
Ingest 278 transactions and documents, extract entities, validate completeness, and assign urgency.
Results you can measure
90%
Accuracy across automated cases
AI employees maintain high precision with built‑in QA scoring.
2–3 weeks
Typical time to go live
Deploy fast without heavy integrations.
Minutes
Turnaround on clean cases
Meet CMS timelines with transparent, documented decisions.
90%
Reliability on end-to-end workflows
Reduce operational costs while improving provider experience.
Works across your existing healthcare systems
