Determine
Confirm whether prior authorization is required for the payer, service, and plan.
DEVELOPED BY DOCTORS
Prior authorization, handled from request to resolution.
Insight Health's Prior Authorization AI Agent automates prior authorization, pre auth, and PA workflows across fax, payer portals, APIs, documents, and the EHR. It gathers the record, submits the request, tracks status, follows up, and keeps staff focused on cases that need clinical judgment.
HIPAA compliantSOC 2 Type IIFHIR R4 and HL7v2
Clinical packet completeReady for submission
PA submittedPayer tracking active
Missing note requestedFollow-up in progress
THE ADMINISTRATIVE BURDEN PRACTICES FACE
43prior authorizations per physician each week
34 hrsof physician and staff time each week
35%of prior authorizations processed electronically
13.6 hrsspent checking status each week
Industry benchmarks summarized from AMA prior authorization research and the 2026 MGMA practice leader poll.
ONE AGENT ACROSS EVERY PA CHANNEL
Move each authorization forward without adding another staff queue.
The agent coordinates the administrative work from the first request through approval, denial, or escalation. Staff can see what happened, what is pending, and what needs a human decision.
Gather
Collect the diagnosis, history, notes, labs, imaging, and payer-specific documentation.
Submit
Send the request through the available API, portal, fax, or phone workflow.
Track
Monitor status, recognize payer updates, and follow up before the case stalls.
Resolve
Route additional information, denials, appeals, and physician review to the right owner.
EVERY INPUT, ONE WORK QUEUE
Fix the workflow underneath prior auth.
Most tools automate a single submission. Insight Health connects the fax, referral, clinical record, payer response, and patient communication so open actions do not disappear between systems.
Explore intelligent document processingRead every payer document
Classify incoming approvals, denials, and requests for more information.
Assemble the clinical packet
Pull the relevant record and write status back to the correct work queue.
Follow the payer's channel
Use APIs, portals, fax, and phone based on what each payer supports.
Keep the patient informed
Send updates and move approved services toward scheduling.
BUILT FOR SPECIALTY OPERATIONS
Prior authorization AI for the workflows with the most moving parts.
Procedures, imaging, and therapy
Coordinate documentation and payer follow-up across high-volume musculoskeletal care.
Time-sensitive treatment pathways
Keep requests and supporting records moving while preserving clinical oversight.
Procedural authorization
Connect referral intake, prep requirements, payer work, and scheduling.
Longitudinal documentation
Gather the history and evidence payers require across recurring interventions.
Complex clinical records
Organize the supporting record and surface exceptions for physician review.
One operating model
Standardize PA status, ownership, and follow-up across sites and service lines.
DEVELOPED BY DOCTORS
Clinical judgment stays with clinicians.
The AI agent handles administrative coordination and keeps a complete action trail. Medical necessity decisions, peer-to-peer conversations, and other clinical judgments remain with the practice.
Human review for exceptionsTransparent status historyRole-based access
PRIOR AUTHORIZATION FAQ
Clear answers for practice leaders.
A practical view of how Prior Authorization AI fits existing teams, EHRs, and payer workflows.
What is a Prior Authorization AI Agent?
It is software that coordinates the administrative steps required to determine, prepare, submit, track, and follow up on a prior authorization request across the EHR and payer channels.
Are prior authorization, pre auth, and PA the same thing?
They are commonly used to describe the same payer approval workflow. Requirements vary by plan, service, medication, and site of care.
Does the AI replace clinical decision making?
No. The agent automates administrative work. Medical necessity, peer-to-peer review, and other clinical judgments remain with licensed clinicians.
Which payer channels can it use?
The workflow can coordinate supported APIs, portals, fax, and phone processes, then write status and next actions back to the practice workflow.
How does it work with the EHR?
Insight Health connects the authorization request to the patient record, gathers relevant documentation, routes tasks to the correct queue, and updates status as the case progresses.
READY TO REMOVE THE PA BOTTLENECK?