Compiles patient history against a payer's specific authorization criteria and submits straightforward requests automatically — cutting the wait between a clinical decision and approved care.
Adjust volume, automation rate and processing time and the agent recalculates hours saved and value protected instantly.
| Metric | Value |
|---|
| 1. Compile the case | Pulls patient history, diagnosis codes and the payer's specific authorization criteria for the request. |
| 2. Match against payer rules | Checks the compiled case against the insurer's published PA criteria before submission. |
| 3. Auto-submit or route | Fully automates straightforward, clearly-qualifying requests, and routes ambiguous cases to a human reviewer with the case pre-compiled. |
| 4. Hand off | Tracks outcomes back to update the payer rule library, and flags denials to the Claims Denial Triage Agent. |