Patients Abandoning Treatment
Patients who hear "waiting for approval" reschedule, delay, or quit. Abandoned treatment isn't a cost saving — it's a sicker patient who costs more to treat later.
Prior Auth Should Manage Cost. Not Everyone's Time.
43 prior auth requests a week per physician — 12 hours lost to admin. Our AI handles routine cases in minutes, complex cases routed with everything reviewers need ready.
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The Problem Is Bigger Than a Slow Process
Prior auth is a clinical risk, not just an admin burden. The damage goes beyond slow turnarounds — every failure compounds on both sides.
Clinical Reviewers Buried in Routine Work
Most requests in the queue are routine — standard treatments approved dozens of times before. They should never reach a reviewer. But they do, and complex cases wait behind them.
Providers Fighting Your System Instead of Working With It
Opaque criteria and unpredictable turnarounds push providers to over-document and hire staff just to chase approvals. That friction doesn't disappear — it lands in your contract negotiations.
Denial Rates Creating Costly Appeal Workloads
Every overturned denial costs you twice — original review plus appeal. And it erodes the provider relationships your members rely on.
Manual Review Means Inconsistent Decisions
Two reviewers, same presentation, different decisions. That inconsistency is a liability — medically, financially, and reputationally.
How the Platform Works — From Submission to Decision
Prior Auth AI decides which requests need a human — and when they do, every reviewer gets a complete, ready-to-decide case. Every step is logged and auditable.
What You Get on the Payer Operations Dashboard
Real-time visibility across the full authorisation pipeline — every request, every reviewer, every decision. No more asking your team for a status update on where things stand.
Live Authorisation Pipeline & Auto-Approval Rate
Every request in the system by status — received, under AI review, pending clinical review, approved, denied, appealed — segmented by plan type, procedure category, provider, and region. Auto-approval rate tracked over time by procedure type and plan, showing how the AI improves as it calibrates to your population.
Clinical Reviewer Workload & Turnaround
Average time from submission to decision for auto-approved requests, human-reviewed requests, and appeals — tracked over time. Reviewer case load, average review time, and queue pressure alerts let your operations team balance workload before a backlog builds.
Denial Analytics & Provider Performance
Denial rate by procedure. Appeal rate by denial reason. Overturn rate on appeals by procedure and rationale. This is where you find patterns that signal your criteria need updating — before providers, regulators, or the press find them. Provider submission quality view supports network management conversations grounded in data.
What Payer Teams Are Experiencing After Going Live
Each result traces to a real problem — buried reviewers, slow turnarounds, denial patterns no one had mapped. Click through to see what changed.
Book a Prior Auth Demo70%
Of reviewer time was going to straightforward approvals. AI handles those now. Reviewers focus on complex cases. Job satisfaction up noticeably. — VP Clinical Operations, National Health Insurer, Mumbai
6 hrs
Average turnaround for routine requests, down from 4.2 days. Provider frustration measurably reduced. Satisfaction scores moved within three months. — Chief Medical Officer, Managed Care Organisation, Bengaluru
80%+
Appeal overturn rate on one cardiac denial reason — caught in analytics. Criteria updated, denials stopped. — Head of Utilisation Management, Regional Health Plan, Hyderabad
83%
Reduction in handling time per request. Routine volume automated from day one. Auto-approval rate improves month-over-month as the AI calibrates.
Zero
Appeal backlog post-implementation. Every appeal arrives with full case history assembled — no reviewer starting from scratch.
Same day
Turnaround for urgent cases. Urgency signals detected automatically from clinical notes. Urgent requests skip the standard queue.
Who This Platform Serves
Built for every payer-side organisation — insurers, managed care, government schemes, TPAs, and self-insured employers.
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Health Insurance Companies
Health Insurance Companies
High request volume, stretched clinical teams, frustrated providers. AI prior auth cuts cost per decision, improves turnaround, and reserves your reviewers for cases that need them.
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Managed Care Organisations
Managed Care Organisations
Meet turnaround, denial, and appeal obligations consistently — without adding clinical headcount every time membership grows.
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Government Health Schemes
Government Health Schemes
Ayushman Bharat, CGHS, and state schemes face volumes no manual process can sustain. AI adjudication built to NHCX, ABHA, and ICD-10 standards handles the load with full audit readiness.
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Third Party Administrators
Third Party Administrators
Hospitals judge you on speed and fairness. AI prior auth delivers faster decisions, cleaner documentation, and fewer appeals — a visible competitive edge across your network.
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Self-Insured Employers & Benefit Administrators
Self-Insured Employers & Benefit Administrators
Manage prior auth without an insurer's clinical infrastructure. Our platform scales with your employee population.
Built to the Standards That Prior Authorisation Actually Operates Under
Every standard is scoped at implementation and built directly into the platform — regulatory compliance, interoperability, coding, and security frameworks for prior authorisation in India and globally.
Indian Regulatory
IRDAI & Government Scheme Compliance
IRDAI and government scheme requirements for prior auth in India — audit trails, turnaround obligations, and reporting.
Interoperability
NHCX, ABHA & FHIR Integration
National and international interoperability standards enabling provider submission through existing EHR workflows.
Coding Standards
Clinical Coding & Classification
Coding standards applied during clinical review and medical necessity assessment.
EHR Integration
Provider System Compatibility
EHR and practice management integrations for direct submission from existing clinical workflows.
Data Privacy & Security
Privacy & Security Frameworks
Privacy and security standards across every data store, transmission, access control, and audit trail.
Audit & Compliance
Full Decision Audit Trail
Every decision logged with criteria applied, outcome, reviewer identity, and timestamp — ready for regulatory review at any time.
Prior Auth Should Protect Clinical Appropriateness. Not Block It.
Prior auth should ensure evidence-based care — not route every request through the same manual process. AI handles the routine. Reviewers focus on what needs expert judgment.
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Frequently Asked Questions
[ 1 ]
How does the AI apply our specific clinical criteria rather than generic guidelines?
The platform is configured around your actual policy guidelines and clinical criteria — not industry generics. During implementation, your clinical and policy team works with us to map your criteria into the system. The AI then applies exactly those criteria, consistently, on every request. When your criteria change, the configuration is updated centrally and takes effect immediately across all request processing.
[ 2 ]
What happens with requests where clinical judgment genuinely differs from guidelines?
Those go to your reviewers — that is the design, not a gap. The platform is not trying to replace clinical judgment. It is trying to remove clinical judgment from the decisions that do not need it, so your reviewers have capacity for the ones that do. Every case that goes to a reviewer comes with a complete summary and the AI's preliminary read, so the reviewer can agree, disagree, or seek additional information with full context.
[ 3 ]
How does this handle urgent and emergency authorisation requests differently?
Urgency scoring is built into the clinical review step. The AI reads urgency signals from the documentation — diagnosis severity, clinical language indicating time-sensitivity, procedure type — and adjusts the routing accordingly. Urgent requests bypass the standard queue and go immediately to a reviewer flagged for same-day decision. Your team never has to hunt through a queue to find the critical cases.
[ 4 ]
Can providers submit through their existing EHR systems?
Yes. The platform supports FHIR-based electronic prior authorisation, which means providers using Epic, Cerner, or other FHIR-compatible EHRs can submit requests directly from their workflow without logging into a separate portal. For providers using systems without FHIR integration, web portal and API submission are also supported.
[ 5 ]
How quickly does the auto-approval rate improve after implementation?
Most payers see meaningful auto-approval on routine requests from week one, because the platform is configured to your criteria before go-live. The rate improves over the following 60 to 90 days as the AI calibrates to your specific population, your provider submission patterns, and the nuances of how your criteria are applied in practice. By month three, most clients are auto-approving the majority of their routine volume.
[ 6 ]
Is the system compliant with IRDAI regulations and Indian health insurance requirements?
Yes. The platform is built to meet IRDAI guidelines on claims and authorisation processing, supports NHCX data standards, integrates with ABHA, and maintains full audit trails for regulatory review. For government schemes, compliance with Ayushman Bharat authorisation requirements and state scheme specifications is supported as part of implementation.
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