AI for Prior Authorization
Attinio’s AI Agents work together from Prior Auth intake to decision communication, reducing administrative burden for your UM teams
Prior Auth Workflow Reimagined
Prior Auth Intake
Member ID: 123
CPT: 99213
AI Agent checks for new Prior Auth request
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Extract and Map Key PA Info
{
"memberId": "12345678",
"cpt": "99213"
} AI Agent extracts the information and auto-fills a UM portal
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Clinical Summary
- • A1C 8.2% (60d)
- • Recent visit: PCP
- • Meds: Metformin
- • Guideline notes
AI Agent summarizes the PA request
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Medical Necessity Guidelines
Coverage Policy
- Criteria A
- Criteria B
- Criteria C
AI Agent converts to a decision tree
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Coverage Criteria
- Meets criterion A
- Docs complete
- No conflict therapy
AI Agent reviews patient medical data against clinical guidelines
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Prior Auth Decision
- ✅ Approved
- ❌ Rejected
- ⚠️ Needs more info
AI Agent recommends a decision with communication language
Our AI Agents for Prior Auth are here to free up your time
Intake Automation AI Agent
- Ingest a PA request received through any source (fax, EHR, etc.)
- Extract key fields from any type of PA request format (structured, unstructured, handwritten, etc.)
- Map to a UM portal
- Cut manual workload required to sift through requests and type into a UM portal
Summarization AI Agent
- AI reads through auth request, clinical documents, and medical history, even if they contain dozens of pages
- Clear and succinct summary of all key information presented to the user
Clinical Review AI Agent
- AI turns Medical Necessity Guidelines into Digital Decision Trees
- Prior Auth request and patient medical history reviewed against guidelines
- Clinical Reviewer received AI-generated recommendations for a final decision along with clear rationale
Decision Communication AI Agent
- AI summarizes the rationale used to review the auth request
- Provides sample language to communicate the final decision along with a letter
Outcomes with Guardrails
Measurable speed, accuracy, and throughput backed by governance at every step.
50%+ Time Savings
Reduced turnaround times
80%+ high accuracy
Fewer data intake errors
Increased Throughput
Process greater volumes of prior auth requests
Governance At Every Step
Governance framework to ensure security and compliance