Payer Rule Fragmentation
Hundreds of payer-specific requirements changed faster than staff could track. The agent maintains a living rule library so every packet reflects the payer's latest policy at submission time.
Cutting Prior Authorization Turnaround from 6 Days to Under 24 Hours
Manual prior authorizations were delaying patient care and consuming staff hours. We deployed an AI agent that submits, tracks, and resolves authorizations autonomously — reclaiming 30+ staff hours a week and cutting first-pass denials by two-thirds.
Automate Your Prior AuthorizationsAbout the Project
A nine-location multi-specialty medical group was spending more time fighting for approvals than delivering care. Prior authorizations for advanced imaging, specialty medications, and outpatient procedures were routed through dozens of payer portals, each with its own rules, forms, and documentation requirements.
We deployed a Bonami X AI Prior Authorization Agent directly inside their existing EHR. The agent reads the order and clinical notes, assembles a payer-specific authorization packet, submits it, and tracks it to resolution — escalating only true exceptions to human staff. Within three months, turnaround dropped from six business days to under twenty-four hours.
- Industry
- Healthcare / Multi-Specialty Medical Group
- Business Type
- Provider Group — 9 Locations
- Core Offering
- AI Prior Authorization Agent (Bonami X AI)
- Integration
- EHR-embedded, HIPAA-compliant
- Build your idea
- Talk to our experts
The Challenge
Authorization staff spent more than 30 hours a week on payer portals, hold queues, and fax follow-ups. Every specialty had a different payer mix, and payer rules changed constantly — so even experienced coordinators struggled to submit clean packets the first time.
The result was an 18% first-pass denial rate, driven mostly by missing clinical evidence and mismatched CPT/ICD codes. Average turnaround stretched to six business days, delaying imaging and specialty treatment. During peak season the backlog forced procedure cancellations and pushed revenue into the next quarter.
The group needed to remove the manual burden without losing clinical oversight or compliance control.
From a 6-day wait
to under 24 hours with
an autonomous auth agent
Talk to Our Team
Our Solution
Automated Payer Submission
- Reads the order and clinical notes, then matches them against current payer-specific authorization rules
- Assembles the complete authorization packet and submits across payer portals, fax, and EDI channels
- Handles each payer's required forms and formatting without manual re-keying
Real-Time Status Tracking
- Continuously polls payer systems for status changes and writes updates back into the EHR
- Surfaces a single live queue of pending, approved, and at-risk authorizations
- Escalates only genuine exceptions to human coordinators — clean cases resolve untouched
Clinical Documentation Assembly
- Pulls the specific chart evidence each payer requires to support medical necessity
- Generates letters of medical necessity and validates CPT/ICD pairings before submission
- Flags documentation gaps to the ordering provider in advance, not after a denial
Denial Prevention & Appeals
- Scores each request for denial risk pre-submission and prompts fixes while they still matter
- Auto-drafts appeal packets with supporting evidence when a denial does occur
- Tracks appeal outcomes to keep the payer rule library continuously current
Key Challenges We Solved
30+ Hours of Manual Work Weekly
Portal logins, hold queues, and fax follow-ups were fully offloaded to the agent, freeing coordinators to focus on the small share of cases that genuinely need human judgment.
18% First-Pass Denial Rate
Pre-submission validation of documentation, codes, and medical-necessity evidence caught the errors that were driving avoidable denials before packets ever left the building.
Care Delays from Slow Approvals
By collapsing turnaround to under 24 hours, patients moved from order to approved treatment in a single day instead of a full week, ending peak-season procedure cancellations.
Why They Chose Us
We built an agent that lives inside the group's existing EHR, keeps PHI secured with full audit logging, and lets staff set the approval thresholds that matter for high-stakes or ambiguous cases.
PHI stays within the group's secured environment, with full audit logging of every action the agent takes on a patient record.
Coordinators work from the same system they already use — no separate app, no new login, no retraining curve.
Approval thresholds and escalation rules are configurable, so staff retain oversight of high-stakes or ambiguous authorizations.
Bonami maintains and updates the payer rule library, so the group never has to chase policy changes across dozens of carriers.
The Results
<24 hrs
Authorization Turnaround
Down from 6 business days
5%
First-Pass Denial Rate
Down from 18%
30+ hrs
Staff Time Reclaimed Weekly
Redirected to patient care
$210K
Annual Revenue Protected
From prevented delays & denials
More Case Studies
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