Healthcare: Prior Auth Automation
What prior authorization automation looks like for behavioral health and multi-location physician practices. HIPAA-covered, BAA-signed, designed to be built and operated by us.
February 15, 2026
What Is the Challenge?
A typical 12-location physician practice spends over $68,000 per physician annually on health plan administrative tasks including prior authorizations (Casalino et al., Health Affairs, 2009). The manual process requires staff to navigate multiple payer portals, track submission status, and manage appeals, consuming roughly 15 hours per week per location.
What Is the Approach?
How We Build This
- Map where the delays actually come from. Before designing anything, we embed with the revenue cycle team and quantify the workflow. The data typically shows roughly 60% of delays are incomplete submissions and missed follow-ups, not payer processing time. The fix follows the finding.
- Assemble the submission automatically. The agent watches the EHR for new orders, pulls clinical documentation and procedure codes, cross-references payer-specific requirements, and flags missing elements before submission. Gaps become a specific checklist for the clinical team instead of a downstream denial.
- Connect to the payers. API connections to the major payers covering most of the practice’s volume, with screen-automation fallbacks where APIs aren’t available. The agent submits, tracks status, and escalates only when human clinical judgment is required (peer-to-peer reviews, complex appeals).
- Measure every decision. Full observability into agent submissions, outcomes, and payer response times drives a continuous improvement loop. First-pass approval rates rise over time because the agent never misses a required attachment or uses an outdated CPT code.
- Retrain the team around exceptions. Staff move from data entry to exception handling. Their clinical expertise goes to the complex cases, not to chasing missing attachments.
Where This Fits Best
Multi-location physician groups with 10+ locations and a centralized revenue cycle team have the scale to justify the build and the operational discipline to absorb the workflow change. Fragmented RCM ownership or small practices see lower ROI: the fixed cost of payer connectivity is hard to amortize at that scale.
What Technologies Are Used?
Want to Learn More?
Results are projected based on our methodology and industry benchmarks. Actual outcomes vary by client environment.