Overview
PriorAuth is a transformative Agentic AI solution that automates and revolutionizes the entire Prior Authorization verification process for insurance payers. By leveraging Agentic AI, natural language processing and machine learning, our solution drastically reduces manual effok, increases accuracy, aligns with CMS Interoperability Regulations of 2027 and accelerates document processing by reducing processing time from hours to minutes.
Our cutting-edge solution leverages Amazon Bedrock Agents to revolutionize Prior Authorization (PA) processing through an advanced Agentic AI architecture. Leveraging sophisticated multi-agent collaborative AI, the solution autonomously ingests and verifies complex medical documentation, including EDI 270/271 transactions, medical necessity documents and historical member data.
It also assesses confidence scores and autonomously generates recommendations (approve, reject, manual review) accompanied by detailed reasoning.
The solution transforms labor-intensive workflows through automation, reducing processing time, minimizing human error and addressing evolving regulatory requirements such as the upcoming CMS Prior Authorization interoperability mandates (of January 2026-27).
Benefits
Productivity Improvement by >75%
Turn Around Time Improvement by > 70% (data exchange and workflow between payers and providers, high turnaround time)
Regulatory Compliance of CMS Prior Authorization interoperability requirements
Agentic AI-based Decision (approve/reject/manual review recommendations) with explanation.
