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.

Silna Health focuses on helping specialty healthcare providers manage prior authorizations, benefits, and eligibility checks. It is designed for use in physical therapy, speech therapy, and behavioral health. Silna automates the authorization process using AI, provides regular benefit and eligibility checks, and sends reminders for expiring authorizations to prevent lapses in care.

Anterior 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.

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 an end-to-end RCM solution for providers. It offers a range of features aimed at improving efficiency and accuracy in tasks such as eligibility and benefits verification, claims management, and prior authorization.

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.

Cohere Health automates and optimizes the prior authorization process for health plans by integrating with EHR systems, digitizing authorization requests, and applying AI and clinical intelligence to automate decisions and improve efficiency. The platform supports real-time analytics and interoperability, facilitating faster patient care and reducing administrative costs.

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.

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 Health uses generative AI to optimize healthcare operations, particularly in pharmacy workflows. The platform integrates with EHR systems using SMART on FHIR, providing functionalities like rapid patient data retrieval, AI-assisted 340B qualification, and automated prior authorizations.

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, formerly PriorAuthNow, is a platform that unites payers and providers to streamline the prior authorization process. It integrates with EHR systems for data exchange, supports communication methods including faxes, and uses intelligent workflows to optimize authorization success rates. The platform provides real-time status updates and facilitates collaboration among healthcare teams through built-in communication tools.

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 a platform that simplifies prior authorizations for buy-and-bill drugs, imaging, and select procedures. It helps providers by managing forms, tracking statuses, and supporting communication with payers. It automates form recommendations, auto-fills information, and updates tracking with responses. SamaCare integrates with EHRs for patient information lookup and two-way synchronization, and supports faxes and payer portals. Built-in communication tools facilitate collaboration among revenue management and clinical staff, improving efficiency and reducing administrative tasks.

Thoughtful AI is an AI Revenue Cycle Automation platform that integrates with EHRs and practice management systems to automate tasks in eligibility verification, patient intake validation, claims processing, payment posting, with additional capabilities in coding, provider management, and revenue reporting.

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.

Waystar's Prior Authorization platform uses intelligent automation to manage the entire authorization process. It automatically verifies, initiates, tracks status, and retrieves authorization details, integrating directly with major EHR systems. The platform automates patient referral status, handles unscheduled admissions, and generates necessary medical notices. It adapts to changing payer rules and is maintained by an in-house team of experts. AI is used to verify if authorization is required, gather data, send documentation, check status, and flag potential issues.