Prior Authorization Agent: Automated PA Workflow
Handles the entire prior authorization process—checking requirements, submitting requests, tracking status, and appealing denials—without human intervention.
Key Capabilities
- PA Requirement Detection - Identifies which services require prior auth by payer
- Auto-Form Completion - Populates PA forms with patient and clinical data
- Clinical Documentation - Attaches notes, lab results, imaging to support medical necessity
- Submission & Tracking - Submits electronically, monitors status, follows up on delays
- Appeal Management - Auto-generates appeals for denied PAs with clinical rationale
- Provider Notification - Alerts provider when PA is approved or additional info needed
- Payer Portal Integration - Works with major payer PA systems
- Audit Trail - Complete logging for compliance
Impact
Time Saved
16 hrs/week
Approval Rate
+25%
Staff Reduction
80%
Submission Speed
Same-day
Technical Details
Integration & Features
- Integration
- Payer PA portals and electronic PA systems
- Clinical Support
- Medical necessity criteria database
- Workflow
- Automated task management and escalation
- Compliance
- Complete audit trail for all submissions
Security & Compliance
- HIPAA Compliant
- SOC 2 Type II Certified
- Real-time processing and logging
- End-to-end encryption
Ready to Deploy Your AI Workforce?
See how Caesar Health agents can transform your practice in a live demo.