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Use Case

Prior Authorization

Medical forms with 3 missing attachments flagged. Complete submission in 24 hours instead of 8 days.

The Problem

Every specialty medication requires prior authorization. Your team fills out the same forms repeatedly, attaches clinical documentation, and submits to insurance. Then the rejections come back: "Missing lab results." "Need 90-day medication history." "Form incomplete on page 3."

Each rejection adds 3-5 days. Patients wait in pain. Providers call asking for status. And your staff spends 40% of their time on rework instead of patient care.

The Automation

Our prior authorization agent manages the entire workflow: extracting patient data from your EHR, pre-populating forms, checking for required attachments, and tracking submissions through approval. It catches missing information before submission, not after rejection.

01

Extract

Pulls patient demographics, diagnosis codes, and medication history from EHR

02

Validate

Checks payer requirements, flags missing clinical documentation

03

Submit

Completes forms, attaches documents, submits via payer portal or fax

04

Track

Monitors status, escalates delays, routes approvals back to clinical team

Prior authorization dashboard showing form status and missing attachments
68%Faster approval
94%First-pass rate
12 hrsPer case saved

Common Missing Items Caught

  • Clinical documentation - Progress notes, lab results, imaging reports required by payer
  • Step therapy proof - Documentation of failed preferred alternatives
  • Specialty provider credentials - Verification prescribing physician is in-network
  • Quantity limit justification - Medical necessity for doses exceeding standard limits
  • Diagnosis specificity - ICD-10 codes with required specificity for approval

Real Results

"Our first-pass approval rate went from 34% to 94%. The agent catches missing attachments before we submit, so we stopped getting rejections for incomplete paperwork. Patients get their medications 5 days faster on average."
- Director of Patient Access, specialty pharmacy

HIPAA-Ready Compliance

Built for healthcare from day one:

  • End-to-end encryption for all PHI
  • Complete audit trail of every action
  • Role-based access controls
  • BAAs available with all major payers
  • On-premise deployment option

Accelerate patient access

Process your first 50 prior authorizations free. See the time savings and approval rate improvement firsthand.

Start free trial