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.

Arrive Health's Prior Authorization solution for providers facilitates real-time access to coverage, cost, and restriction information within the EHR. It automatically initiates the prior authorization process, and shows potential alternative treatment options in the EHR.

Availity Essentials is a healthcare provider portal designed to streamline various healthcare administrative and management processes. Key features include patient management tools for eligibility and benefits checks, insurance information, and care reminders, along with a comprehensive claims management system for submitting, tracking, and correcting claims. The platform provides electronic remittance advice for easier claim and payment research, and a provider data management system for updating provider information. Additionally, Availity Essentials simplifies prior authorization and referral processes.

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.

Change Healthcare's Clearance Authorization software is a comprehensive solution designed to streamline prior authorization workflows in healthcare settings. It automates the process of verifying if pre-authorizations are required and on file, directly submitting requests to integrated payers. The software incorporates real-time checking of clinical codes for Medicare compliance and helps minimize denials and financial losses associated with patient care pre-authorizations. Additionally, it includes tools to manage medical necessity checks and create Advanced Beneficiary Notices, ensuring that financial liability is communicated effectively to patients before service delivery.

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.

CoverMyMeds helps automate prior authorization for medications, connecting healthcare networks to improve patient medication access. It integrates with over 500 EHR systems, linking healthcare providers, pharmacies, and payers to streamline prescribing and approval.

Develop Health is an AI-enabled eligibility checking and prior authorization platform for medication that automatically calls payers to get benefits details, verifies clinical documentation against plan criteria, and automates form-filling across payer portals for faster authorization.

Ethermed is an AI-enabled prior authorization solution that helps determine authorization status, pulls clinical documentation, and automatically fills and submits requests for providers.

Experian Health's Prior Authorization enables the management of prior authorizations for providers, handling inquiries and submissions automatically. It connects to a comprehensive database that regularly updates with national and local payer requirements, ensuring that users have access to the most current information. The software supports various connection types to payers and employs AI to guide users through the workflow.

Fairway Health is an AI assistant designed for health insurers to expedite the prior authorization process for patient treatments. The platform uses large language models (LLMs) to analyze extensive and complex medical records, determining patient eligibility for specific treatments.

FastAuth streamlines prior authorization by verifying patient demographics and insurance eligibility, and automating manual steps in the prior authorization process. It helps in managing authorizations across various payers and utilization managers, enabling healthcare providers to quickly ascertain specific payer requirements and make better patient decisions.

Glidian is prior authorization platform focused on interoperability between providers and payers. It supports integration methods including manual entry, X12 278, HL7, CSV, and API for prior authorization submissions, and consolidates all authorizations in a single dashboard for real-time status updates.

Humata Health provides an AI-driven platform designed to automate the prior authorization process in healthcare. It integrates with EHRs and payer systems to streamline authorizations, using machine learning for intelligent document recommendations and one-click submissions. The platform prioritizes cases, monitors for changes, and automates status updates to improve efficiency and reduce manual work.

Latent uses AI to streamline specialty pharmacy and infusion prior authorization for hospitals and clinics.

Myndshft helps automate prior authorizations for acute and post-acute services, imaging labs, and diagnostics and genomics labs. The product uses a library of payer rules and an AI-enabled system that updates the workflow and rules engines based on previous prior authorization requests.

Rhyme Health streamlines prior authorization by connecting EHR systems and insurance carriers for faster submission and approval. Rhyme is geared to both health plan and provider processes and emphasize a network solution to better connect payers and providers.

RxLightning is a prior authorization platform that automates and simplifies the onboarding process for specialty medications. It provides healthcare providers with tools to complete patient enrollment forms, conduct benefit checks, manage prior authorizations, collect consents, and access patient assistance programs.

SamaCare is prior authorization platform primarily for buy-and-bill drugs, but can also be used for imaging and select procedures. The platform automates form-filling in payer portals, schedules reminders and auto-renewals, and identifies actions to speed up authorizations and reduce denials.

Silna uses AI to streamline prior authorizations, benefits and eligibility checks for therapists.

Valer Health's Prior Authorization solution is designed to reduce the time and effort typically required for managing prior authorizations by eliminating manual processes. It automates submissions and status checks through a single platform that integrates with the EHR and practice management system. Additionally, it helps pre-populate payer web portal and fax details with accurate patient information for faster processing times.