Prior-authorisation packet assembly for a regional health system
Regional health system, Ohio
- Challenge
- Referral coordinators assembled prior-authorisation requests by hand, pulling clinical notes, imaging reports and payer-specific forms from three systems. Each packet took 40 to 60 minutes, payer rejections for incomplete submissions ran at about one in five, and the backlog delayed some procedures by weeks.
- Solution
- We built an agent that drafts each packet from the order, selecting the correct payer form, gathering the supporting documents and highlighting where the clinical criteria are met. A coordinator reviews and submits; nothing leaves the system without human sign-off. All access is logged against the patient record.
- Results
- Packet preparation time down from 50 minutes to 12
- Payer rejections for incomplete submissions fell from 21% to 7%
- Backlog cleared in 6 weeks across 4 specialty clinics
