Our AI for Prior Authorizations solution first processes the patients medical records, regardless of volume and format to perform data extraction. Information extracted includes: Patient information, Code detection, Machine learning / LLM detection that is specific to the prior authorization.

Data extracted is then evaluated to validate that the records are for the same patient as the prior authorization is being evaluated for. The data is then reduced to information that is relevant to the prior authorization and consolidated to either JSON (optionally FHIR as USCDI or Base R4) or highlighted PDF. This PDF has highlights indicating approval or denial evidences in color-specific formatting based on the typed of evidence (green for approval, red for denial). Reviewers are able to jump through processed records quickly to see these evidences.

Need more information on how AI-powered prior auth can improve your processes, visit our blog for more information.