Prior Authorization

Prior Authorization products serve as a bridge between healthcare providers and payers, streamlining the authorization process for treatments and medications. These tools facilitate the submission of clinical documentation by clinicians, making it easier for payers to review and authorize necessary procedures. On the other side, payers benefit from organized systems to manage and respond to treatment requests from healthcare providers efficiently. AI and machine learning, are increasingly employed within these products to assess the relevance and necessity of treatments, as well as to generate the prior authorization submissions themselves.

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Claims Clearinghouse

Clinical Documentation Integrity

Eligibility Checking

End-to-End Revenue Cycle Management

Medical Coding

Patient Billing and Collection

Availity

Availity Essentials

Prior Authorization

End-to-End Revenue Cycle Management

Eligibility Checking

Claims Clearinghouse

Availity Essentials is a healthcare provider portal offering functionalities like eligibility and benefits checking , claims processing, remittance advice, provider information management, prior authorization and referral management.

Banjo Health

AI Prior Authorization for Payers (UM)

Prior Authorization

Banjo Health streamlines the prior authorization process for health plans and pharmacy benefit managers.

Basys.ai

AI Prior Authorization for Payers (UM)

Prior Authorization

Basys.ai uses AI to streamline prior authorization for health plans and systems.

Co:Helm

AI Prior Authorization for Payers (UM)

Prior Authorization

Co:Helm is a generative AI platform for payer organizations, providing a co-pilot dashboard to improve UM nurse efficiency.

Cohere Health

AI Prior Authorization for Payers (UM)

Prior Authorization

Cohere Health streamlines prior authorization processes using automation and machine learning.

CoverMyMeds

Prior Authorization

CoverMyMeds helps automate prior authorization for medications, connecting healthcare networks to improve patient medication access.

Develop Health

AI Prior Authorization for Providers

Prior Authorization

Eligibility Checking

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

AI Prior Authorization for Providers

Prior 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.

Fairway Health

AI Prior Authorization for Payers (UM)

Prior Authorization

Fairway Health is an AI assistant for health insurers that uses LLMs to analyze medical records and make prior authorization determinations.

FastAuth

Prior Authorization

FastAuth is a prior authorization platform that helps automate patient insurance eligibility and approval.

Latent

AI Prior Authorization for Providers

Prior Authorization

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

Myndshft

AI Prior Authorization for Providers

Prior Authorization

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

Prior Authorization

Rhyme Health streamlines prior authorization by connecting EHR systems and insurance carriers for faster submission and approval.

SamaCare

Prior Authorization

AI Prior Authorization for Providers

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 Health

Silna

AI Prior Authorization for Providers

Prior Authorization

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