The prior authorization (PA) process in healthcare is often slow, inconsistent and heavily manual, leading to delays in care, administrative inefficiencies and compliance risks. HCLTech’s smart prior authorization solution addresses those challenges by deploying a modular, AI-powered system that validates eligibility, provider credentials, procedures and documentation through specialized agents. It uses AI-driven confidence scoring to determine whether to auto-approve, deny or escalate requests for manual review, cutting turnaround time to under 2 days while ensuring compliance and oversight.

Unlike traditional automation, this solution leverages large language models (LLMs) for advanced reasoning and adaptability to evolving clinical and policy guidelines. Its cloud-native, scalable architecture integrates seamlessly with claims and care management systems. The system also supports diverse data formats and delivers explainable, traceable decisions with human oversight.