AI EMPLOYEES
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.
Prior Authorization (Payers)
Healthcare Payers
2,600
Running
90%
Accuracy across automated cases
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
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.
What healthcare payers are saying
“Magical helped us modernize prior authorization without adding staff. Our turnaround times dropped from days to hours, and provider complaints virtually disappeared.”
“Magical gave us real-time visibility into every authorization. For the first time, we can track performance, accuracy, and compliance—all in one dashboard.”
Security & compliance
HIPAA compliant
Magical processes all data locally with zero PHI storage
SOC 2 Type II certified
Enterprise-grade security with regular third-party audits
Secure Authentication
Single Sign-On (SSO) and multi-factor authentication options
See a payer prior auth demo
How does this help with CMS prior auth rules?
Agents track turnaround times, maintain audit logs, and generate transparent notifications to support compliance.
What accuracy can we expect?
Most payers achieve 90%+ accuracy on automated cases with AI judge oversight and exception routing.
How do you integrate with our UM platform?
We work alongside systems like HealthEdge and QNXT; no heavy integration is required to start.
How fast can we pilot?
Most pilots start within 2–3 weeks focused on a narrow scope (e.g., a procedure category or line of business).
Is data secure?
Yes—HIPAA compliant with full encryption and least‑privilege access controls.
