Prior auth done better with generative AI

Authorization Advisor efficiently extracts and presents key information from the EHR. It connects to the EHR via a standards-based integration to access the data needed and supports additional data sources (like scanned docs). Then it presents those details in a convenient interactive sidebar on the payer portal.

Using our powerful GenAI technology, Authorization Advisor reviews relevant medical information and recommends documents to include in auth requests, along with evidence-based justifications. The technology then pulls those suggestions into the sidebar for the RCM team to evaluate.

The solution rapidly populates the patient details into the auth submission on the payer portal. It eliminates the need to toggle back and forth between screens — everything is right there. Staff then reviews Authorization Advisor's proposals for clinical documents in the sidebar, selecting and attaching the appropriate ones. Finally, they submit the auth, recording the response details in the EHR.

Our technology continuously learns from documents the prior auth specialists select and what answers they choose on the auth form. The AI uses all of this knowledge to improve how it operates and the suggestions it makes.

Our automation validates if an auth is required and then fills out the auth requests on payer portals — including supplemental diagnosis and procedure codes and required medical records. Unlike other tools, we leverage GenAI to review relevant medical information, finding clinical documents a human may miss and suggesting relevant ones. This workflow also determines if an auth is not required and documents that in the EHR. We ensure your auths are thorough and accurate in order to improve turnaround time.

Our technology obtains well-timed auth statuses for pending auth requests. It returns detailed information to drive follow-up workflows and documents the claim with approved, pending, or denied status and portal screenshots.