Prior authorization is one of the most operationally complex processes for TPAs and health plans. We've built an AI-powered workflow platform that replaces manual, PDF-driven workflows with policy-aware AI.
Manual workflows, disconnected systems, and outdated processes create bottlenecks at every step.
Most payors run prior authorization across a patchwork of claims systems, provider directories, and data formats. This fragmentation makes it hard to standardize workflows, apply policies consistently, or automate reviews.
Nurses spend hours reading handwritten notes and hunting for missing fields, which means they are wasting time on non-clinicial administrative work.
Two reviewers can interpret the same documentation differently, leading to inconsistent approvals and frustrated providers.
These inefficiencies have real consequences for payors, providers, and patients.
Many denials happen due to missing signatures or incomplete forms, not lack of medical necessity, causing unnecessary delays and extra, costly administrative work.
Reviews take days even for straightforward cases, directly impacting patient outcomes when urgent treatment is needed.
New CMS prior auth rules require 72-hour turnarounds and current processes simply cannot keep pace.
Manual prior auth workflows increase costs for payors and require the clinicians they employ to spend time on tedious, unnecessary tasks.
We don't replace your current medical policies—we help you execute them faster and more consistently.
Automatically read and normalize PDFs, faxes, and scanned documents—extracting relevant clinical information from thousands of pages instantly.
Use your existing clinical criteria (InterQual, MCG, or custom guidelines) to evaluate requests with near perfect consistency across all cases.
Auto-approve clear-cut cases and route complex ones to the appropriate clinical reviewer with all relevant data pre-organized.
See how leading TPAs and health plans use AI-powered workflows to cut costs, improve accuracy, and deliver a better provider experience.