Prior authorization from days to hours
78%
reduction in prior-auth turnaround time
91%
of packets approved on first submission
100%
clinician review before every submission
The challenge
Where it started.
Prior authorization consumed nurse-hours the client couldn't hire fast enough: gathering clinical evidence from EHR records, matching payer-specific requirements, and chasing status across portals. Turnaround stretched to days, delaying care and frustrating providers.
The approach
How we built it.
Decomposed the prior-auth workflow into agent-executable steps with clinicians mapping every judgment point.
Built evidence-assembly agents on Zorat with HIPAA-compliant infrastructure and least-privilege EHR access.
Every packet routes through clinician review before submission — human sign-off is a design requirement, not a fallback.
Fine-tuned extraction models on the client's clinical documentation to handle specialty-specific terminology.