Prior Authorization
Prior authorization processing delays treatment. ActionAI extracts clinical data, applies payer rules, submits to portals, and tracks status, eliminating administrative delays.
78%
Faster approvals
99.1%
Criteria matching accuracy
<4 wks
Time to deploy
01
The Problem
Prior authorisation delays are affecting patient outcomes
Clinical staff spend ~45 minutes per request extracting documentation, navigating payer portals, and tracking status. Delays in submission slow patient care, while incomplete requests lead to denials, resubmissions, and rework. Each rejected request returns patients to the queue and postpones treatment.
02
How It Works
Automated PA workflows from request to approval
ActionAI extracts clinical documentation from your EHR and applies payer-specific requirements before submission. Incomplete requests are flagged before filing, so gaps can be addressed before denial. Approved requests are returned to clinical staff with full context. Each submission includes a confidence score, indicating which requests are likely to clear and which require review.
03
The Outcome
3× faster approvals, fewer denials, better patient outcomes
Your team reduces prior authorization time from 45 minutes to 15 minutes per request. Denial rates decrease as incomplete submissions are identified early. Clinical staff spend less time on payer portals and more time on patient care, while faster approvals allow treatment to begin sooner.
Results that speak for themselves
78%
Authorization speed increase
Reduced treatment delays
99.1%
Payer criteria accuracy
Per-field verification against payer rules
Zero
Payer criteria accuracy
Every requirement checked before submission
Healthcare
Healthcare documentation is the legal record: file a prior auth against the wrong payer policy and treatment slides two weeks to the right. A procedure code that doesn't match the chart loops the claim through three appeal cycles before anyone catches it. Ground truth is the payer policy and coding guideline controlling the decision in front of you. ActionAI scores every automated claim and prior auth against those controlling rules, and high-confidence decisions release without a reviewer opening the file. Below threshold, ExEx (Explainable Exceptions) pulls the case and routes it to the reviewer with the failed rule and source chart attached, so they open the case knowing what needs attention.
Related Use Cases
Frequently asked questions
Prior authorizations, medical coding, claim denials, and scheduling — any workflow where an AI is scoring against a known truth source. Each automation deploys individually, so a health system can start with one process and expand.
Cases that score below threshold drop out of the automated flow and route to a human reviewer with full context, under the Explainable Exceptions (ExEx) protocol. Nothing below threshold gets auto-submitted.
No. ActionAI runs on top of the systems you already have, through API or data export — no replacement needed. Clinicians and administrators keep the interface they know.
SOC2 compliant with SSO and encryption, deployed in cloud, VPC, or on-premises based on what the environment requires. The deployment model gets set in the initial scoping call.
A 1-2 hour scoping call identifies the highest-ROI process, followed by a free pilot on real data — days to weeks, not months. Impact is measured from your own data during the pilot.