Key takeaways
- An agent gathers the chart documentation for an order, matches it to the payer's published criteria and drafts the prior-authorization request with each source cited.
- H2O Document AI reads faxed referrals, orders and prior-authorization packets and returns the fields your team keys by hand today.
- Nothing reaches a payer until a person on your team approves it, and the payer makes every coverage decision.
- The first run is shadow mode on last quarter's requests, so you see how close each draft is before it touches a live case.
Every prior authorization is assembled by hand
Your prior-authorization team reads an order, opens the chart, finds the notes, results and history that support medical necessity, and checks them against the payer's criteria. Then they fill in the payer's form or portal, attach the documents and track the answer.
Each payer asks for something slightly different, and the criteria change. What slows care down is the labor of assembling proof, one request at a time, while the patient waits. A request that goes out incomplete comes back as a pend, a denial or a phone call, so the work is not only slow, it is repeated.