AutonomizeAI's Prior Auth Copilot extracts and summarizes member authorization requests, links clinical data to internal sources, and assesses compliance with clinical guidelines. It generates decision summaries that help reduce administrative burdens and speed up approvals.

Banjo Health streamlines the prior authorization process for health plans and pharmacy benefit managers. BanjoPA is their prior authorization platform for health plans that consolidates prior authorization requests, provides decision recommendation based on predefined clinical decisions trees, and creates documentation to support appeal processes. Banjo Composer takes clinical criteria as inputs and creates clinical decision trees by automatically identifying decisions points and delivering in a platform that supports editing and testing.

Basys.ai is an AI-powered platform that streamlines prior authorization (PA) for health plans using GenAI for policy encoding and request processing. It enables rapid payer onboarding and policy updates, automates complex policy rules and decision logic, and allows UM nurses to verify recommendations while making decisions. The platform recommends alternative care pathways when requests don’t match existing policies and records overrides for analytics and model improvement. It features a portal for direct document submission, API integration with Epic, and OCR for handling document types like fax.

Co:Helm is a generative AI platform for payer organizations, providing a co-pilot dashboard to empower UM nurses to get all of the right data summarized and presented so they can make the right decision faster.

Cohere Unify Platform helps health plans to streamline the prior authorization process using automation and AI. It digitizes PA requests and integrates with electronic medical records, then automates decision-making based on health plan policies, checks for missing information, and supports clinical review processes.

GenHealth.ai 's Auto Prior Auth system automates the prior authorization process for healthcare providers and insurers with auditable, explainable decisions. It uses AI to extract patient data from various sources, including faxes, HL7v2, and call center transcripts. The system ingests medical policies and generates decision recommendations based on plan-specific workflows. It provides early abuse detection, individual risk assessments, and provider gold card recommendations.

Machinify offers AI-driven software for payers for prior authorization, billing, and auditing processes. Products include Machinify Precision Auth, which automates the review and authorization of medical treatments, Machinify Precision Audit, which uses AI for clinical review of claims to prevent unnecessary procedures, and Machinify Precision Payments, which ensures accurate billing by automating error detection and payment reviews. These tools aim to improve care appropriateness, reduce costs, and enhance efficiency for both patients and payers.