Prior Authorization Automation
We automate the mechanical parts of that loop while leaving clinical judgment where it belongs. Requests are assembled from structured EHR data, submitted through the payer channel that actually works for that plan, polled on a schedule, and escalated to a human the moment a case needs one.
What breaks today
Portal sprawl
Each payer has its own portal, its own login policy, and its own idea of what a complete request looks like. Staff carry that difference in their heads.
Silent stalls
A request that sits in pending for eleven days looks identical to one submitted this morning. Nobody finds out until the patient calls.
Re-keyed clinical data
Diagnosis codes, procedure codes, and clinical notes already exist in the chart. They get retyped into a web form anyway, which is where transcription errors enter.
No queue visibility
Leadership cannot answer basic questions: how many authorizations are open, which payer is slowest, which service line is bleeding time.
What we build
Scoped during the assessment, then delivered in one to three week increments against your real systems.
Request assembly from the chart
We pull the order, diagnosis, procedure codes, and supporting documentation directly from the EHR through FHIR, HL7, or a database-level integration, and assemble a payer-specific packet.
Multi-channel submission
Payer APIs where they exist, X12 278 where the clearinghouse supports it, and supervised browser automation for the portals that offer nothing else. Every path is logged.
Scheduled status polling
Open cases are checked on a cadence tuned per payer. Status changes update the worklist and the chart without anyone logging in.
Escalation with a named owner
Cases that stall past their SLA, get a request for additional information, or come back denied are routed to a specific person with the full history attached.
Operational reporting
Turnaround time by payer, by service line, by CPT. The report your revenue cycle director has been building by hand in a spreadsheet.
What changes
Ranges reflect what comparable engagements have produced. Your baseline is measured during the assessment before anyone commits to a number.
- 40 to 60 percent reduction in staff time spent on authorization follow-up
- Median turnaround measured and trended per payer instead of estimated
- Stalled cases surfaced within one polling cycle rather than at patient contact
- A complete audit trail of every submission and status check for payer disputes
Systems this touches
Integration channel is chosen on verified capability in your environment, not on what is easiest to document.
- Epic
- Oracle Health (Cerner)
- athenahealth
- eClinicalWorks
- Availity
- Change Healthcare
- X12 278
Not sure this is the right workflow to start with? The $24,997 assessment exists to answer exactly that, and it frequently points somewhere other than where leadership expected.
Common Questions
Does the automation make clinical decisions about medical necessity?
No. We automate assembly, submission, polling, and routing. Clinical content comes from the ordering provider and the chart. Any case that requires judgment is escalated to a named human owner with the full history attached.
What happens with payers who have no API?
We use supervised browser automation against the payer portal, running inside your controlled environment under credentials your organization owns. Every action is logged, and the automation stops and escalates rather than guessing when the portal changes.
Is PHI stored outside our environment?
Only where you approve it, and only under a signed BAA. Most prior authorization builds we deliver run inside the client’s own cloud tenant so PHI never leaves infrastructure you control.
Talk it through with an engineer.
Tell us what this workflow costs you today and we will tell you honestly whether automating it is worth the engagement.
Start with a conversation, not a proposal.
A 45-minute call with a senior engineer. We will tell you honestly whether automation is the right answer for the workflow you have in mind.