Prior authorization and denial management, automated on your billing systems
We build and run automation for the slow, manual parts of the revenue cycle: prior authorizations, denial work queues, authorization tracking and incoming faxes and referrals. It works inside the systems you already use, and your staff review the cases that need a person.
The Problem
What gets in the way
Prior authorizations by phone, fax and portal
Staff submit and chase authorizations across many payer portals, and status checks take hours each week.
Denials worked one at a time
Denied claims are worked case by case, with no clear view of the causes that keep repeating.
Faxes and referrals typed in by hand
Incoming faxes and referral documents are read and re-entered into the EHR, which is slow and error-prone.
Authorization units tracked in spreadsheets
In ABA and other therapy services, used and remaining units are tracked by hand, and a missed reassessment becomes a denial.
What We Build
What we build and run for you
Payer portal automation
Submitting authorizations and checking their status across payer portals, including those with logins and one-time codes.
Denial work queues
Denials sorted by cause and routed to the right person, with the documents needed to appeal.
Fax and referral intake
Incoming documents read, sorted and turned into structured fields, then passed to your team to confirm.
Authorization tracking
Used and remaining units, expiry dates and reassessment dates tracked, with alerts before they lapse.
Reports on what is causing losses
Denial causes, turnaround times and recovered revenue, by payer and by site.
AI Engineering
AI for reading and drafting
Language models read incoming faxes, referrals and denial letters and pull out the fields your team needs. They can also prepare a first draft of an appeal from the denial reason and the record, which your staff review and send.
About our AI engineeringHow It Works
From first call to running every day
- 1
Pick the most costly workflow
We measure where staff time and revenue are lost and start with the workflow that costs the most.
- 2
Build on your systems
The automation works with your EHR, billing system and payer portals. Nothing is replaced.
- 3
Run it with people in the loop
The system handles routine cases. Your staff review exceptions, and we monitor and adjust it every day.
- 4
Move to the next workflow
Once the first workflow runs well, we take on the next one.
Revenue-cycle automation: common questions
No. Clearinghouses handle standard transactions well. We automate the work around them that is still done by hand.
Yes. The same portal automation that runs our credentialing engine handles logins, one-time codes and CAPTCHAs.
Yes. Routine cases are handled automatically, and anything unclear goes to your staff with the documents they need to decide.
Your EHR and billing system, payer portals and fax lines. We connect through whatever access each system provides.
Tell us which workflow is slowing your team down.
Book a call with an engineer. We will look at your systems and tell you whether we can help.
Book a Meeting