Healthcare
Prior-authorisation automation
Cut the administrative burden of prior authorisation by assembling clinical evidence and drafting submissions, with a licensed clinician owning every adverse determination.
The problem
What this fixes.
Built for Payer and provider operations leaders facing prior-authorisation volumes, timelines and the 2026-27 electronic-PA mandates.
Prior authorisation is slow, manual and loathed by clinicians and patients alike.
Evidence gathering across records and policy is pure administrative waste.
Regulation requires a licensed clinician, not an algorithm, on any adverse decision.
How we deliver it
From problem to production.
01
Gather
Relevant clinical evidence and the applicable medical policy are assembled for each request.
02
Draft
On the provider side, the submission is drafted from the evidence for clinician review.
03
Accelerate
Clear approvals are surfaced quickly; only genuine exceptions consume clinician time.
04
Decide
A licensed clinician owns every denial, with the full evidence and policy in front of them.
Outcomes
What good looks like.
0%
Reduction in review queue
0%
Faster turnaround on clear approvals
0%
Adverse decisions owned by a clinician
Indicative ranges drawn from comparable engagements, measured against a pre-AI baseline. Your figures are set and tracked from your own data during delivery.
What you get
Shipped, owned, documented.
Every engagement hands over working software in your repositories, with the evidence to run and audit it.
Clinical evidence and policy assembly per request
Submission drafting for provider-side workflows
Approval acceleration with clinician exception queue
CMS electronic-PA aligned reporting
HIPAA-mapped governance and audit pack
Questions
What buyers ask first.
The design supports electronic prior authorisation and decision-timeline reporting in line with the CMS rules phasing in through 2026 and 2027, and keeps a licensed clinician on every adverse determination as several states now require.
The AI attacks the administrative burden - evidence gathering and drafting - not the clinical decision. Approvals can be accelerated; denials are always a human clinical judgement. That boundary is the whole governance posture.
Capabilities behind it