Prior Authorisation Agent
Prepares and submits requests for insurer approval of treatment, then follows them up, so staff handle only the exceptions.
The challenge
Staff copy information from documents into systems by hand. It is slow, and mistakes are found late.
How it works
- 1A document or file arrives.
- 2The agent reads it and picks out the details.
- 3It checks those details against your data and your rules.
- 4Items that pass are entered into your system.
- 5It confirms each entry was recorded correctly.
- 6Items that do not match go to your team, with the difference explained.
Your people stay in control
The checks follow fixed rules that you set. Your team sees every item that does not match, and nothing unusual is entered without them.
Systems we work with in Healthcare
- Electronic health records via FHIR and HL7
- Practice management and scheduling
- Payer portals and clearing houses
- Contact-centre telephony
- Imaging and lab systems
How we measure success
- How many items go through without manual work
- How accurate the captured details are
- Cost per item processed
Kind of work
Document and data processing. The agent reads documents, checks the details and enters them into your systems.
More in Healthcare
Clinical Intake & Triage AgentAnswers patients at any hour, asks about their symptoms, judges how urgent the case is and directs them to the right care.Clinical Note-Taking AgentListens to the appointment, writes up the clinical notes and prepares the orders for the clinician to check and sign.Claim Denial Management AgentReads why an insurer refused a claim, writes the appeal with supporting evidence and resubmits it.Post-Discharge Follow-up AgentCalls or messages patients after they leave hospital, checks for warning signs and books follow-up appointments.
Want this working in your organisation?
We can show it working on real examples from your business before you commit to a full build.