Prior Authorization Software
AI-assisted prior authorization software that detects when authorization is needed, gathers the clinical evidence to support it, and tracks submission through to payer response - see it live against Epic's FHIR sandbox in our public demo.
The problem
Where healthcare organizations get stuck
Missed or expired authorization drives preventable denials
A missing or expired prior authorization is a completely avoidable denial reason - and one of the most common.
Assembling clinical evidence for payer criteria is manual and slow
Matching a payer's specific medical necessity criteria against a patient's chart is tedious, time-consuming, manual work today.
Authorization requirements vary by payer and change over time
What requires authorization - and what evidence satisfies it - differs by payer and shifts as policies update, making static checklists go stale.
What we build
Capabilities
Authorization requirement detection
Confirms whether a specific procedure requires authorization for a specific patient's specific plan before work begins.
AI-assisted clinical evidence extraction
Extracts and organizes supporting evidence from the chart against a payer's specific criteria, flagging gaps before submission.
Payer-specific criteria matching
Maps chart documentation against each payer's published medical necessity criteria, not a generic checklist.
Da Vinci PAS / CRD submission
Structured, API-based submission where a payer supports Da Vinci standards.
Portal & fax submission fallback
A reliable human-assisted path for the many payers that still require portal or fax submission.
Status tracking & appeals workflow
Tracks a request through pending, approved, denied, or additional-information-requested status, routing denials back for resolution.
EHR & clinical data integration
Pulls real clinical context - diagnoses, prior treatments, results - directly from your EHR via FHIR.
Human-in-the-loop clinical review
Every AI-assisted extraction is reviewed by clinical staff before submission - never auto-submitted.
How we work
Our process
Map your payer mix and their specific authorization requirements
Integrate with your EHR/clinical data source for evidence gathering
Build AI-assisted evidence extraction against payer medical necessity criteria
Connect submission - Da Vinci PAS where supported, portal/fax fallback otherwise
Track status through to approval, denial, or appeal, with clinical staff review throughout
Related services
How we deliver this
FAQ
Common questions
Related solutions
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