Custom Prior Authorization Automation AI Agent

AI Agent Built into Your EHR to Accelerate Prior Authorization Approvals

Automate payer rule detection, submission validation, and real-time tracking directly within your clinical and RCM workflows to shorten turnaround times and reduce approval delays.

RCM-Integrated Auth
Workflows

Payer Logic at
Point-of-Care

Authorization Tracking
Dashboards

Automated Appeals
Routing

RCM-Integrated Prior Authorization Workflows

Integrated Prior Authorization: Prevent Delays Before They Happen.

Custom EHR software dashboard with voice-assistant feature on custom EHR mobile app showcasing AI scribing

RCM-Integrated Prior Authorization Workflows

Integrated Prior Authorization: Prevent Delays Before They Happen.

Automatically trigger AI prior authorization workflows during order entry, ensuring required approvals begin immediately, reducing turnaround time and preventing scheduling delays before services are delivered.

Match ordered procedures with payer-specific authorization rules in real time, detecting approval requirements instantly and eliminating manual eligibility checks across payer portals with a prior authorization AI agent.

Connect authorization status directly to your claims workflow, through prior authorization automation software, preventing claims submission without required approvals and reducing rework, denials, and unnecessary revenue cycle delays.

Use AI-driven prior authorization automation to identify high-risk or high-value cases, prioritizing revenue-sensitive approvals across your RCM operations.

Route tasks within your automated prior authorization solution, improving team accountability and reducing administrative burden across the healthcare revenue cycle.

Payer Logic at Point-of-Care

Payer Requirements at the Point of Care: Know Before You Order.

Patient appointment scheduling screen on custom EHR

Payer Logic at Point-of-Care

Payer Requirements at the Point of Care: Know Before You Order.

Validate payer-specific prior authorization requirements instantly at the point of care, ensuring ordered procedures meet coverage rules before submission and reducing manual eligibility verification steps.

Automatically review clinical documentation for medical necessity criteria using AI prior authorization logic, flagging missing justification before submission to improve first-pass approval rates.

Generate proactive alerts when services exceed payer coverage limitations, helping providers adjust orders or documentation early and reducing preventable authorization rejections.

Verify referral requirements in real time during order entry, ensuring compliance with payer policies and preventing authorization delays caused by incomplete referral documentation.

Detect prior authorization requirements before an order is finalized, allowing staff to initiate workflows immediately and avoid post-visit delays that disrupt scheduling and revenue flow.

Authorization Tracking Dashboards

Prior Auth Tracking: Monitor Every Request in Real Time.

Patient portal dashboard in custom EHR with pop-up with specific patient records detailed

Authorization Tracking Dashboards

Prior Auth Tracking: Monitor Every Request in Real Time.

View live prior authorization status in your prior authorization automation software updates across pending, approved, and denied requests, eliminating manual follow-ups and improving transparency within your clinical and RCM workflows.

Track prior authorization turnaround times by payer, specialty, and service type to identify approval delays and optimize authorization workflow efficiency through AI prior authorization.

Identify workflow bottlenecks within your automated prior authorization solution, enabling proactive intervention before pending cases impact scheduling or revenue recognition.

Analyze payer-specific prior authorization performance using AI-driven metrics to compare approval rates, average response times, and denial patterns across your payer mix.

Automatically trigger escalation alerts for delayed or high-value authorization requests, ensuring revenue-sensitive cases receive timely follow-up within your RCM operation.

Automated Appeals Routing

AI-Driven Appeals: Categorize, Generate, Route.

Custom EHR dashboard of providers and mHealth EHR app interface

Automated Appeals Routing

AI-Driven Appeals: Categorize, Generate, Route

Automatically generate structured appeal documentation using prior authorization AI logic, reducing manual drafting time while improving consistency and medical necessity justification.

Classify prior authorization denials by payer, procedure, and documentation gaps to identify recurring issues and improve future submission accuracy.

Format appeal submissions according to payer-specific guidelines, ensuring compliance with documentation standards and reducing rejections caused by incorrect formatting.

Automatically attach required clinical documentation, lab results, and provider notes to appeal submissions, minimizing incomplete resubmissions and accelerating reconsideration timelines.

Track appeal outcomes, approval rates, and resolution timelines to measure effectiveness and refine your automated prior authorization strategy across payers.

WHO IT’S FOR & WHAT PROBLEM IT SOLVES

Built for Teams Managing High-Volume Prior Authorizations

AI-driven prior authorization automation designed to reduce delays, prevent denials, and streamline disconnected revenue workflows.

Multi-Specialty Clinics & Provider Groups

Manual prior authorization workflows delay scheduling, overwhelm staff, and trigger preventable denials. Our custom AI agent embeds automation directly into your EHR and RCM systems to accelerate approvals.

Revenue Cycle Management (RCM) Teams

Authorization gaps cause rejected claims, rework, and delayed reimbursements. This prior authorization AI agent integrates into your revenue workflows to validate submissions and protect cash flow.

Healthcare IT & Digital Leaders

Disconnected authorization tools create integration complexity and data silos. We design a custom prior authorization AI agent built into your system architecture for seamless, scalable workflow automation.

Faster AI Adoption

Electronic Health Records (EHR)

Reduced Risk

Hospital Information Systems (HIS)

Scalable Infrastructure

Revenue Cycle Management (RCM)

Aligned AI Investments

Patient Management Systems (PMS)

What Are Prior Authorization Delays Costing You?

Explore how a custom AI agent can reduce delays, prevent denials, and embed automation directly into your clinical and RCM workflows.

Client Testimonials

Trusted by Healthcare Leaders Driving Revenue Performance

Healthcare providers and revenue leaders trust our custom prior authorization AI agents to reduce delays, prevent denials, and protect revenue workflows.

"Prior authorizations were slowing everything down..."

After deploying the custom AI agent, requests initiate at order entry, and approvals move faster. We’ve reduced preventable denials and improved visibility across clinical and billing teams.

Madeline Prescott
Director of Operations, Multi-Specialty Clinic

"Denials were hurting our cash flow..."

The prior authorization AI agent integrated directly into our RCM workflow, validating submissions before claims. We’ve seen fewer reworks and stronger first-pass approval rates.

Brianna Sinclair
VP of Revenue Cycle, Regional Provider Group

"We needed deeper workflow integration..."

This wasn’t another bolt-on tool. The custom AI agent was built into our EHR architecture, aligning payer logic with claims workflows and eliminating disconnected authorization tracking.

David Whitaker
CIO, Healthcare Network

"Authorization bottlenecks delayed revenue..."

Real-time payer rule validation and automated tracking helped us identify delays early, prioritize high-value cases, and stabilize approval turnaround times.

Ethan McAllister
Senior Director, Revenue Operations

"Appeals lacked consistency and speed..."

AI-generated appeal drafts and structured routing within our revenue workflows reduced manual effort and improved appeal approval timelines across multiple payer contracts.

Christopher Bennett
Managing Partner, Healthcare RCM Firm

"Scaling made authorization chaos worse..."

As we added new providers and locations, manual prior authorization workflows became unsustainable. The custom AI agent standardized payer logic, accelerated approvals, and gave leadership real-time visibility across our entire revenue cycle.

Amanda Brooks
Chief Operating Officer, Regional Healthcare Group

WHY THINKITIVE?

Empowering Healthcare Technology Innovation

250+

Healthcare Projects

400+

Healthcare Experts

98%

Client Retention Rate

150+

Healthcare Customers

50%

Cost Saving on Development

Ready to Eliminate Manual Pre-Authorization Work?

Discover how a custom prior authorization AI agent can streamline approvals, reduce denials, and integrate seamlessly into your EHR and revenue cycle workflows.

Frequently Asked Questions

Get answers to all your questions

Still have questions ?

Our AI prior authorization software supports major commercial insurers, Medicare, Medicaid, and regional payers. Because it’s a custom-built prior authorization AI agent, payer logic is configured to your specific payer mix, ensuring accurate rule validation, submission workflows, and automated prior authorization processing across both national and local plans.

The prior authorization automation engine continuously updates payer-specific clinical policies through configurable rule management and structured policy ingestion. Our prior authorization AI agent enables real-time rule updates, keeping your EHR-integrated prior authorization automation aligned with evolving coverage criteria and reducing authorization denials caused by outdated requirements.

Yes. The EHR-integrated prior authorization AI agent automatically retrieves relevant clinical documentation, including provider notes, lab results, imaging reports, and diagnosis codes. This automated prior authorization solution ensures required attachments are included before submission, improving first-pass approval rates and reducing rework caused by incomplete documentation.

Organizations implementing our AI prior authorization automation typically see measurable improvements in first-pass approval rates by validating payer rules and documentation before submission. By preventing incomplete or non-compliant requests, the prior authorization AI agent helps reduce prior authorization denials and accelerates overall approval turnaround time.

The prior authorization AI agent identifies peer-to-peer review triggers and automatically routes cases to designated clinical staff with required documentation. It tracks deadlines, prepares structured case summaries, and integrates updates into your revenue cycle workflow to minimize delays and protect reimbursement.

Yes. Our prior authorization automation software includes real-time dashboards for tracking pending, approved, and denied requests. This automated prior authorization solution improves visibility across clinical and RCM teams, enabling proactive follow-up and reducing revenue delays caused by stalled approvals.

The AI prior authorization software supports electronic prior authorization (ePA) for medications and procedure-based authorization requests. It validates payer-specific requirements, checks medical-necessity criteria, and submits via integrated payer portals or APIs as part of your automated prior authorization workflow.

Our automated prior authorization solution uses secure credential vaulting and compliant authentication workflows to manage payer portals requiring multi-factor authentication. The prior authorization AI agent operates within HIPAA-aligned security frameworks, ensuring encrypted data exchange while maintaining operational continuity.

Yes. The prior authorization automation engine generates real-time denial alerts and categorizes denial reasons. It routes cases for correction or appeal within your RCM workflow, helping teams reduce prior authorization denials and prevent downstream claim rejections.