AI for Healthcare
Prior-Auth & Claims Agent
An AI agent that takes prior-authorization requests end to end, capturing clinical context, checking medical necessity against payer criteria, auto-approving the clear cases and routing the rest, so approvals are faster, cheaper and no longer a source of care delays.
- Intake PA requests with clinical documentation from any channel
- Medical-necessity evaluation against payer-specific clinical criteria
- Auto-approve clear cases; route edge cases to clinicians with evidence attached
- Real-time status, SLA tracking and automated appeals
Platform Overview
Six modules, one authorization journey
From request intake to decision and appeal, the agent keeps providers, payers and patients on the same fast, evidence-backed path.
Request Intake
Any channel · Complete packet
Capture
- Portal, fax, EHR & referral intake
- Auto-assemble the clinical documentation packet
- Service, code & diagnosis capture
- Missing-information detection
Medical Necessity
Criteria-based decisions
Evaluate
- Evaluate against evidence-based clinical criteria
- Auto-approve clear cases
- Route ambiguous cases to clinical review
- Confidence scoring per determination
Payer Rules Engine
Per-payer requirements
Comply
- Payer-specific PA requirement lookup
- Code & policy mapping
- Formulary & site-of-care rules
- Requirement change tracking
Clinical Evidence
Grounded & cited
Justify
- Pull relevant history from the EHR
- Cite guidelines behind every decision
- Attach evidence to the determination
- Human-in-the-loop clinician oversight
Status & Turnaround
Transparent SLAs
Track
- Real-time authorization status
- SLA & turnaround monitoring
- Automated appeal generation
- Notifications to provider & member
Provider Experience
Less friction · Fewer delays
Optimize
- Reduce back-and-forth with payers
- Approval-rate & cycle-time analytics
- Denial root-cause insight
- Every decision logged & auditable
Faster approvals, without the administrative drag
Prior authorization is one of healthcare's biggest sources of cost, burnout and care delay. An evidence-grounded agent removes the manual burden while keeping clinicians in control.
Faster Approvals
Clear cases are authorized automatically in real time instead of waiting in a manual queue.
- Real-time decisions
- Auto-approvals
- Shorter queues
Less Admin Load
The agent assembles packets and checks requirements, freeing staff and clinicians from paperwork.
- Auto-assembled packets
- Less staff time
- Reduced burnout
Fewer Care Delays
Faster, criteria-based determinations mean patients start needed care sooner.
- Sooner to treatment
- Fewer abandonments
- Better outcomes
Evidence & Compliance
Every determination is grounded in cited criteria and logged for audit, with clinician oversight.
- Cited criteria
- Clinician-in-loop
- Full audit trail
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