Determine
Confirm whether prior authorization is required for the payer, service, and plan.
DEVELOPED BY DOCTORS
Prior authorization, handled from request to resolution.
Our Prior Auth AI Agent is AI prior authorization software for specialty groups. It works across fax, payer portals, APIs, documents, and the EHR. We gather the record, submit the request, track status, follow up, and keep staff focused on cases that need clinical judgment.
HIPAA compliant.SOC 2 Type II.FHIR R4 and HL7v2.
Last updated: October 21, 2026
Clinical packet completeReady for submission
Prior auth submittedPayer tracking active
Missing note requestedFollow-up in progress
THE ADMINISTRATIVE BURDEN PRACTICES FACE
40prior authorizations per physician each week
13 hrsof physician and staff time on prior auth each week
40%of physicians have staff who work exclusively on prior auth
95%of physicians report care delays
Figures are according to the American Medical Association's 2025 prior authorization physician survey of 1,000 physicians.
ONE AGENT ACROSS EVERY PRIOR AUTH 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.
HOW IT WORKS
How AI prior authorization automation works
AI prior authorization uses software agents to run the administrative steps of a prior auth request. Our Prior Auth AI Agent reads payer rules, the chart, and faxed records. It builds and checks the packet, then submits it through API, portal, fax, or phone. It tracks the case to a decision, while staff and clinicians review the exceptions.
Prior auth is the newest extension of our document platform and is in pilot, so treat our own performance figures on this page as targets, not production results.
Determine: read the payer's rules
The agent reads the payer's rules for the plan and service. It confirms whether prior auth is required before anyone builds a packet.
Gather: score the packet before it goes out
The agent reads the chart and the faxed records tied to the request. The workflow is designed to score the documentation against payer-specific and procedure-specific criteria, and to catch ICD-10 coding errors before submission so they do not turn into denials.
Submit: route each request by readiness
The workflow is designed to give every request a readiness score. At 95% or higher, it is designed to submit automatically. When minor information is missing, it routes the request to a coordinator for gap-fill. When a critical clinical detail needs clarification, it is designed to send the provider a short micro-questionnaire. The agent then submits through the channel each payer supports: API, portal, fax, or phone. Humans stay on the exceptions by design.
Track: follow up against payer deadlines
The agent monitors status and follows up before the case stalls. CMS-0057-F is the federal rule that requires impacted payers to decide prior auth requests faster and support electronic requests. According to CMS, impacted payers, such as Medicare Advantage, Medicaid, and CHIP plans, must send decisions for medical items and services (not drugs) within 72 hours for expedited requests and seven calendar days for standard requests.
CMS also states that its Prior Authorization API requirement begins January 1, 2027. We are building for CMS-0057-F with FHIR PAS API readiness. FHIR PAS is an HL7 FHIR implementation guide CMS recommends for prior auth APIs. Ask your compliance team how the rule applies to your group.
Resolve: clinicians keep the clinical calls
Requests for more information, denials, and appeals route to the right owner. Medical necessity decisions and peer-to-peer conversations stay with clinicians.
EVERY INPUT, ONE WORK QUEUE
Fix the workflow underneath prior auth.
Most tools automate a single submission. We connect the fax, referral, clinical record, payer response, and patient communication so open actions do not disappear between systems.
Prior auth runs on the same packet MagicDocs already read from the referral or fax, and our Referrals AI Agent keeps that referral moving. Denial documents return to the appeals queue with the referral context attached.
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
AI prior authorization for the workflows with the most moving parts.
Procedures, imaging, and therapy
Coordinate documentation and payer follow-up across high-volume musculoskeletal care. See our orthopedic prior authorization workflows.
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. See how we handle pain and spine intake.
Complex clinical records
Organize the supporting record and surface exceptions for physician review.
One operating model
Standardize prior auth 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. Our platform is built by practicing physicians and routes work across sites with role-based access.
Human review for exceptions.Transparent status history.Role-based access.
PRIOR AUTHORIZATION FAQ
Clear answers for practice leaders.
A practical view of how the Prior Auth AI Agent fits existing teams, EHRs, and payer workflows.
How does AI prior authorization work?
Our Prior Auth AI Agent checks payer rules and reads the chart and faxed records. The workflow is designed to score the packet before submission and route requests that are not ready to a coordinator or provider. It submits through API, portal, fax, or phone, then tracks status and follows up until the case resolves.
Can AI automate prior authorization for clinics?
Yes, for the administrative work. Our agent is designed to handle the requirement check, packet assembly, submission, status checks, and follow-up. Medical necessity decisions and peer-to-peer conversations stay with clinicians. We built it for specialty groups, MSOs, and health systems with 10 to 100+ providers.
Which EHRs does it integrate with?
The platform integrations listed on our EHR integrations page are Epic, athenahealth, AdvancedMD, DrChrono, eClinicalWorks, CharmHealth, NextGen, Elation Health, CGM Aprima, Office Practicum, Medicat, and Veradigm. We also support standards-based connections through FHIR R4 and HL7v2. Our team confirms prior auth write-back for your specific EHR during scoping.
How does it handle pain management injection authorizations?
The agent gathers the history and evidence payers require across recurring interventions. For epidural steroid injections, our research projects submission time dropping from 45 minutes to under 5. Our first-pass approval target is above 90%. These are pilot-stage targets from our research, not production results.
Is it HIPAA compliant?
Yes. HIPAA is the federal law that sets rules for protecting patient health information. SOC 2 Type II is an independent audit that tests a company's security controls over time. Everything we build meets HIPAA and SOC 2 Type II standards. Our S.A.F.E. architecture (Supervised Autonomous Framework for Evaluations) supervises the agent in production, and a full audit trail records what the AI did and what a person changed. Review our trust and safety controls.
How fast is implementation?
The timeline depends on your EHR integration path and your security review. Teams can start standalone and route work to the Insight work queue while EHR write-back is completed.
What should we look for in AI prior authorization software?
Look for EHR integration, specialty logic, and multi-channel submission across API, portal, fax, and phone. Require human review on exceptions and a full audit trail. Ask for HIPAA and SOC 2 Type II evidence.
EHR INTEGRATIONS
Integrates with your EHR
Our Prior Auth AI Agent writes status back to the correct work queue in your EHR. Our team confirms prior auth write-back for your specific EHR during scoping. These are the platform integrations listed on our EHR integrations page, plus the standards we connect through:
EpicathenahealthAdvancedMDDrChronoeClinicalWorksCharmHealthNextGenElation HealthCGM AprimaOffice PracticumMedicatVeradigmFHIR R4HL7v2
READY TO REMOVE THE PRIOR AUTH BOTTLENECK?