Automated Prior Authorization Solutions for Healthcare RCM

Automated Prior Authorization Solutions for Healthcare RCM

Streamline prior authorization workflows. Reduce delays, cut denials, and improve revenue with Automation Agents combining RPA, AI, and Document Understanding.

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Prior Authorization and Verification Automation Services

Automated Prior Authorization Solutions for Healthcare RCM

Streamline prior authorization workflows. Reduce delays, cut denials, and improve revenue with Automation Agents combining RPA, AI, and Document Understanding.

A PROVEN HEALTHCARE AUTOMATION PARTNER:

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TRUSTED BY U.S. CLINICS AND HOSPITALS TO DELIVER REAL  ROI THROUGH AGENTIC AI AUTOMATION.

Trusted by U.S. clinics and hospitals to deliver real ROI through AGENTIC AI automation.

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Accelerate Your Revenue Cycle with Prior Authorization Automation

Automated prior authorization isn’t the future – it’s the now. Clinics using our Automation Agents reduce time-to-payment, improve their Patient Satisfaction Score and gain full control over the revenue cycle.

Get started with intelligent automation that plugs into your systems and delivers measurable ROI from day one.

What You Can Automate in the Prior Authorization?

Eligibility and Requirement Detection

Automatically analyze patient data, treatment plans, and payer rules to determine whether a prior authorization is required.

Data Extraction and Form Population

Leverage OCR and AI to pull patient demographics, diagnoses, physician info, and clinical notes and auto-fill prior auth forms.

Submission, Tracking and Alerts

Submit authorizations via payer portals, monitor status continuously, and trigger alerts or appeal workflows when needed.

Eligibility and Requirement Detection

Automatically analyze patient data, treatment plans, and payer rules to determine whether a prior authorization is required.

Data Extraction and Form Population

Leverage OCR and AI to pull patient demographics, diagnoses, physician info, and clinical notes and auto-fill prior auth forms.

Submission, Tracking and Alerts

Submit authorizations via payer portals, monitor status continuously, and trigger alerts or appeal workflows when needed.

HOW DOES IT WORK IN PRACTICE? [CASE STUDY]

Automated Prior Authorization in Action

For a leading healthtech company from the US we have automated the whole prior authorization process and build autonomous integrations connecting with various insurers’ middleware systems, Electronic Health Records, and NPI Registry.

13 FTEs

saved monthly

15K items

processed/monthly

7

insurers systems connected

~$700K

yearly savings

Why Automate Prior Authorization with our RCM Automation Agents?

Automate identification of PA requirements using RPA and Agentic AI. Clinics using similar tools report 78% auto-approval rates in under 90 seconds, drastically reducing delays.

Automate form submission, real-time tracking, and appeals prep. Denials linked to documentation or authorization account for nearly 14% of initial denials, making this automation critical to prevent revenue loss.

By handling up to 75% of routine PA tasks, these systems enable potential savings of up to $15.8 B annually for U.S. healthcare providers—and $3.60+ per request.

Automating time-consuming PA tasks boosts team efficiency by 200‑300%, freeing your staff to focus on care coordination and exception handling .

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Faster Approvals

Automate identification of PA requirements using RPA and Agentic AI. Clinics using similar tools report 78% auto-approval rates in under 90 seconds, drastically reducing delays .

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Lower Denials

Automate form submission, real-time tracking, and appeals prep. Denials linked to documentation or authorization account for nearly 14% of initial denials, making this automation critical to prevent revenue loss.

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Significant ROI

By handling up to 75% of routine PA tasks, these systems enable potential savings of up to $15.8 B annually for U.S. healthcare providers—and $3.60+ per request.

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Improved Staff Productivity

Automating time-consuming PA tasks boosts team efficiency by 200‑300%, freeing your staff to focus on care coordination and exception handling .

Explore RCM Automation Agents for Every Stage of your Revenue Cycle Management

Building Your First Automated Prior Authorization Workflow Today

Schedule a free consulting session and see the live demo of your potential use case.

Transform Your Prior Authorisation Workflows

Let’s explore together what RPA + AI can do for your team.

Streamlining Prior Authorization and Verification with RPA: Enhancing Healthcare Revenue Cycle Management

Efficient management of revenue cycle processes is crucial for healthcare organizations to optimize their financial operations. The Prior Authorization and Verification stage plays a significant role in these processes. Explore how Robotic Process Automation (RPA) can bring efficiency and accuracy to healthcare organizations by automating these critical workflows.
Understanding prior authorization and verification ensures that healthcare providers receive approval from insurance payers before performing specific medical procedures or treatments. Verification involves confirming patient insurance coverage and eligibility before providing services.

What Are the Automated Workflows for Prior Authorization and Verification?

Automated Eligibility Verification

RPA retrieves patient information from multiple sources, such as electronic health records (EHRs) and insurance portals, to verify insurance coverage and patient eligibility. This automation streamlines the process, reduces manual effort, and minimizes errors.

 

Automated Prior Authorization Requests

RPA generates and electronically submits prior authorization requests. Bots collect patient and procedure details, populate forms accurately, and forward them to the appropriate insurance payer. This eliminates manual paperwork, expedites the process, and reduces potential errors.

 

Automated Follow-up Communications

 

RPA bots track and follow up on prior authorization requests. They communicate with insurance payers, confirm request receipt, and monitor approval status. Automating these follow-up tasks minimizes delays, expedites patient care, and ensures timely approvals.

Benefits of RPA Automation for Prior Authorization and Verification

Enhanced Efficiency and Reduced Manual Effort

RPA eliminates manual data entry, form filling, and repetitive prior authorization and verification tasks. This frees up staff to focus on higher-value activities, improving overall efficiency.

Improved Accuracy and Compliance

RPA automates the validation of prior authorization requirements, ensuring adherence to payer guidelines and protocols. This reduces errors, improves compliance, and minimizes denials or reimbursement delays.

Faster Turnaround Times

RPA expedites prior authorization and verification processes. Bots retrieve and analyze data swiftly, submit requests promptly, and monitor progress continuously. Streamlining these workflows leads to faster approvals, reduced patient wait times, and timely initiation of treatments.

Why RPA for Prior Authorization and Verification Automation?

Reduced Costs and Increased Revenue

RPA automation reduces administrative costs associated with manual processes. By eliminating the need for additional staff and minimizing errors, healthcare organizations can achieve cost savings and improved reimbursement rates.

Enhanced Patient Satisfaction

Automation simplifies the prior authorization process, reducing wait times and providing a smoother patient experience. Faster access to necessary treatments boosts patient satisfaction with healthcare providers.

Scalability and Flexibility

RPA allows healthcare organizations to scale prior authorization and verification processes seamlessly. Bots handle higher workloads without compromising accuracy or efficiency, accommodating increasing volumes.

Top Automated Prior Authorization Solutions for Healthcare Providers!

RPA and AI significantly benefits revenue cycle management’s Prior Authorization and Verification stage. Automating workflows, RPA enhances efficiency, reduces manual effort, and improves accuracy and compliance. With reduced costs, faster turnaround times, and enhanced patient satisfaction, RPA offers healthcare organizations a valuable tool to streamline their revenue cycle management and optimize their financial health. Embracing prior authorization automation services through RPA enables healthcare providers to focus on delivering high-quality patient care while achieving greater operational efficiency.

Bring RCM Automation Agents to Your Team!

Schedule a free consulting session with our RCM Automation experts.

What are the tasks of prior authorization?2024-01-29T20:46:45+01:00

Prior authorization tasks in RCM involve submitting requests, verifying eligibility, evaluating medical necessity, documenting and communicating information, and receiving approval or denial decisions. By automating these tasks, healthcare providers can streamline the process, reduce manual effort, improve accuracy, and expedite approvals. Automation technology facilitates seamless communication between providers and insurance companies, ensuring efficient exchange of information and adherence to insurance guidelines.

What is electronic prior authorization?2024-01-29T20:45:32+01:00

Electronic prior authorization (ePA) is a digital process that automates and streamlines the prior authorization workflow in healthcare. It replaces traditional manual methods by electronically exchanging information between healthcare providers and insurance companies. ePA enables real-time submission, review, and approval of authorization requests, reducing paperwork, delays, and administrative burden. This digital system improves efficiency, accelerates the authorization process, reduces errors, and enhances overall RCM by ensuring timely access to necessary medical treatments and services.

What are the benefits of automating prior authorization?2024-01-29T20:44:36+01:00

Automating prior authorization in healthcare RCM processes improves operational efficiency by streamlining the authorization workflow, reducing manual tasks, and accelerating the approval process. Automated systems ensure accuracy and compliance by consistently applying payer guidelines and medical necessity criteria. This reduces errors, minimizes denials, and enhances revenue cycle performance. Additionally, automation reduces administrative costs, enhances resource utilization, and improves patient experience by expediting access to necessary medical services.

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