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.

Ethermed offers an AI-driven solution that automates the prior authorization process in healthcare, aiming to reduce up to 90% of manual administrative tasks. Operating seamlessly within existing systems, it gathers necessary clinical data, completes authorization forms, and submits them without manual input, thereby minimizing delays in patient care. This technology benefits both healthcare providers and payers by decreasing administrative burdens and enhancing operational efficiency.

Janus Health’s Prior Authorization solution uses unattended intelligent automation to reduce manual work in securing payer approvals, integrating directly with existing EHR workflows. It automates key steps—determination, initiation, and status tracking—by logging into payer portals, retrieving requirements, and returning results to the EHR, complete with documentation screenshots

Notable's Intelligent Authorizations automates the prior authorization process, reducing manual tasks for healthcare providers. It integrates with EHRs to identify authorization needs, submit requests, and track statuses directly within patient records. The platform aims to reduce denials and administrative workload, supporting faster patient care by automating interactions with payer portals.

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. It automates benefit verification, clinical eligibility checks, and prior authorization form completion, and automatically calls payers to get benefit details. By integrating patient insurance data and clinical history, the platform increases first-time approval rates and reduces delays in accessing medications.

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.

Fig Medical provides AI-powered clinical decision support for streamlining prior authorization (PA) processes. It integrates directly into EHR systems, offering transparency into payer guidelines and ensuring that PA requests are correctly set up from the outset. This solution helps healthcare providers reduce administrative burdens and improve efficiency in managing authorizations at the point of care.

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.

Itiliti Health offers a prior authorization automation platform that improves the efficiency of managing prior authorization requests for payers and providers. The solution leverages APIs and interoperability to streamline workflows, ensure compliance, and reduce administrative burdens. Their key offerings include the PA Checkpoint tool for determining authorization requirements and automating clinical decision-making processes.

Lamar Health offers DoPriorAuth, a platform that automates specialty medication workflows for infusion centers and specialty pharmacies. It extracts data from faxes or emails, integrates it into electronic health records or practice management systems, verifies patient eligibility and network status, and auto-populates prior authorization forms. The platform provides real-time feedback on payer policies and approvals, aiming to reduce staff workload, minimize errors, and expedite the time to fill prescriptions.

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.

Mandolin is an AI-powered automation platform designed to assist infusion centers with back-office tasks directly within electronic health records (EHR). It focuses on buy-and-bill operations, managing payer policies, financial assistance programs, and prior authorization forms. Mandolin automates processes such as referral management, document tracking, and patient scheduling to reduce administrative workload and improve operational efficiency.

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.

Orbit Healthcare Inc. provides AI-powered solutions for healthcare providers, focusing on insurance data capture, verification, prior authorization, and revenue cycle management. Their platform automates insurance card data extraction, prior authorization tracking, and claims processing to reduce errors and denials. Additional capabilities include document processing, patient scheduling, and coverage discovery. These services are designed to optimize administrative workflows and improve overall efficiency for healthcare organizations.

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.

RISA Labs offers AI-powered automation solutions for managing prior authorizations in healthcare, focusing on reducing denial rates, administrative workload, and compliance risks. Its platform integrates with major EHR systems and utilizes advanced AI to optimize first-time submission success and streamline workflows. RISA’s tools include proactive denial prevention and real-time compliance monitoring, aimed at minimizing rejections and financial losses for both healthcare providers and payers.

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.

SureScripts Electronic Prior Authorization integrates with EHRs to allow prescribers to initiate and receive prior authorization requests and responses directly within their workflow. It supports both prospective and retrospective authorizations.

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.