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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 Authorizations

About the Project

A nine-location medical group routed prior authorizations for imaging, specialty medications, and procedures through dozens of payer portals. Our Bonami X AI Prior Authorization Agent runs inside their EHR — reading orders and notes, assembling payer-specific packets, and tracking to resolution in under 24 hours.

Industry

Healthcare / Multi-Specialty Medical Group

Imaging, specialty medications, and outpatient procedures across many payer mixes.

  • Multi-Specialty
  • Advanced Imaging
  • Outpatient Procedures
Business Type

Provider Group — 9 Locations

One authorization team serving nine sites and dozens of payer portals.

  • Provider Group
  • 9 Locations
  • Central Auth Team
Core Offering

AI Prior Authorization Agent (Bonami X AI)

Reads the order, assembles the payer packet, submits it, and tracks it to resolution.

  • Payer Rule Library
  • Packet Assembly
  • Status Tracking
  • Appeal Drafting
Integration

EHR-embedded, HIPAA-compliant

Coordinators work in the EHR they already use, with full audit logging of every action.

  • EHR-Embedded
  • PHI Secured
  • Audit Logging
  • Human-in-the-Loop
Impact

Under 24-Hour Turnaround in Three Months

Down from six business days, with first-pass denials cut from 18% to 5%.

  • <24 hr Turnaround
  • 5% Denial Rate
  • 30+ Hours Reclaimed
Build your idea

Talk to our experts

Scope your own prior authorization agent with our healthcare AI team.

  • Free Consultation

The Challenge

Manual authorizations delayed care and burned staff hours.

30+ Hrs/Wk
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.
18% Denials
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, and peak-season backlogs forced procedure cancellations.
No Compromise
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

    Automated Payer Submission

    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

    Real-Time Status Tracking

    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

    Clinical Documentation Assembly

    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

    Denial Prevention & Appeals

    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
  • Payer Rule Library Upkeep

    Payer Rule Library Upkeep

    Payer Rule Library Upkeep

    • Payer policy changes tracked and versioned as they publish
    • Rule updates tested against recent cases before going live
    • Coordinators see which rule drove each submission decision

Key Challenges We Solved

Hover a row to see what changed.

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.

The Results

Every number below was measured in production after launch — not projected in a pitch deck.

<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

Global presence

Three offices. One team.

Hi, I'm ARIA. Ask me anything about Bonami's AI agents.