Problems

What will AGI do for Prior Authorization Backlog?

Healthcare providers and revenue cycle teams face a severe bottleneck when securing prior authorization for medical treatments from payers. Medical staff manually extract clinical evidence from dense Electronic Health Records to justify medical necessity for each specific procedure. This manual review cycle creates a permanent backlog of pending approvals, delaying patient care and stalling revenue recognition.

The opportunity

What AGI will do for Prior Authorization Backlog

  • Autonomous Payer Submission for Oncology

    Business-as-Code

    Solves:

    Platform.do
  • Clinical Extraction for Orthopedic Clinics

    Business-as-Code

    Solves:

    Platform.do
  • Medical Necessity Generation for Pharmacies

    Business-as-Code

    Solves:

    Platform.do
  • Auth Policy Matching for Home Health

    Business-as-Code

    Solves:

    Platform.do
  • Prior Auth Triage for Hospitals

    Business-as-Code

    Solves:

    Platform.do

The work itself

Grounded Work Profile

Tools

  • EpicproblemCurrentSolutions
  • Cerner MillenniumproblemCurrentSolutions
  • Availity EssentialsproblemCurrentSolutions
  • RightFaxproblemCurrentSolutions
  • UiPathproblemCurrentSolutions

Measured by

  • Severity 4/5problemSeverityFrequency
  • continuousproblemSeverityFrequency

Value flow

How Prior Authorization Backlog connects

candidate solution for

  • Adjudicatevaultmodel
  • Expediteordermodel
  • Packetdomemodel
  • Patexpeditemodel
  • Protocolmodel
  • Regeedmodel

serves

  • association management companies (amcs) teamsmodel

addresses (incoming)

  • Prior Authorization Specialistmodel

entails (incoming)

  • Licensed Therapist Attritionmodel

How AGI delivers it

Four ways AGI delivers

  • Services-as-Software

    Get the professional outcome delivered as software, priced on results, not headcount.

    Services.do
  • Autonomous Agents as digital employees

    Hire a digital employee that does the job under earned, supervised autonomy.

    Agents.do