Prior authorization, worked end to end.
The workflow we build most often in healthcare — what the agent actually does, where a human stays in the loop, and the arithmetic behind the business case.
What it costs today.
A prior-authorization request arrives as a fax, a portal task, or an EHR order. Someone opens the payer's policy, hunts the chart for each documentation element it requires, assembles a packet, submits it, and waits. When it comes back denied, the appeal starts the same hunt over again.
Five steps, every time.
Read the request
The agent extracts the CPT/HCPCS code, the ordering provider, and the member's plan from whatever format it arrived in.
Pull the right policy
It retrieves the payer's current medical-necessity policy for that exact code — the version in force today, not a cached copy.
Check the chart against it
Each documentation element the policy requires is checked against the record, and what's missing is named specifically.
Assemble and cite
It drafts the packet with every clinical assertion linked to the note it came from, so a reviewer can verify in seconds.
Human approves
A person signs off before anything is submitted. The agent never makes the clinical call.
Every determination is reviewed by a person before submission. The agent assembles and cites; it does not decide medical necessity.
Where the value actually is.
We do not publish results we have not earned. What follows is the arithmetic we would build the business case from, using your numbers — not a claim about someone else’s outcome.
Staff minutes per authorization, multiplied by monthly volume, at your loaded hourly cost.
Denials that were never appealed because appealing them didn't pencil out at manual cost.
Both. The packet gets assembled faster, and appeals that were previously uneconomic become worth filing.
This page describes the method rather than a delivered result. Run your own numbers in the ROI calculator, or read the prior-authorization solution page. The Readiness Map is refund-backed precisely because the first number should be yours, not ours.
The same method, different work.
Contract review, clause by clause.
First-pass review against your own playbook — what the agent flags, what it never decide…
Read the caseRockets AI, live at UToledo.
A campus assistant answering student questions from the University’s own pages — plus the transfer-credit workflow we build next.
Read the casePut your numbers in it.
Tell us the workflow and the monthly volume. You get a real figure back within one business day.