Healthcare
Clinical coding support
Coders get a ranked list of candidate codes with the supporting text from the record, looked up in the official code sets, for them to accept or change.
Custom app
Healthcare · Agent
Prior authorisation packets
AI prior authorization requests prepared for staff review
Prior authorisation requests are assembled from the record against each payer's criteria, with missing evidence flagged, then submitted by staff.
01 today
The problem
Each payer has its own forms, portals and criteria. Staff dig through the record for the right notes and results, then wait on hold or refresh portals. Requests come back for missing information, care is delayed and some patients give up on the treatment.
02 the run
What the AI does
- Step 1: Spots orders that need authorisation for the patient's plan, such as imaging, procedures or specialty drugs.
- Step 2: Reads the payer's published criteria for that service and builds a checklist.
- Step 3: Pulls the matching evidence from the record, such as prior treatments tried, test results and notes, with page references.
- Step 4: Fills the payer's form or portal fields and flags anything the record does not show.
- Step 5: Tracks each request's status and alerts staff to requests for more information and to approaching deadlines.
paused: waiting for a person to approve
03 human in the loop
Where a person approves
Staff review and submit every request. Anything the record does not support goes back to the clinician, and the tool never adds clinical facts that are not documented.
04 after
What changes
Requests go in complete the first time, so fewer come back and patients wait less. Staff spend less time on hold and in portals, and nothing is lost between teams.
Case studyPrior authorisations that go in complete the first timeThe rollout, what to measure, a worked example and the research behind it.see also
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Automation
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