Processes

What will AGI do for Manage pre-authorizations?

AI-deliverabilitydigital

With no child occupations seeded, this scalar relies on the APQC process name and description. 'Authorizing claims prior to submittal' under the 'Service products after sales' category represents pure information processing. Because claims verification and pre-authorization consist of document review, administrative rule-checking, and electronic communication rather than physical tasks, the process falls firmly into the digital band.

A provider, employee, or customer submits a request for prior approval of a service, treatment, or expenditure.

Trigger: A provider, employee, or customer submits a request for prior approval of a service, treatment, or expenditure.
Outcome: A formal decision to approve, deny, or modify the request is recorded in the system and communicated to the submitter.

The work itself

Grounded Work Profile

Measured by

Pre-authorization Turnaround TimeprocessProfile
First-Pass Approval RateprocessProfile
Denial RateprocessProfile
Cost Per AuthorizationprocessProfile

Key steps

Receive pre-authorization request and supporting documentationprocessProfile
Verify eligibility and coverage limitsprocessProfile
Evaluate request against policy rules and guidelinesprocessProfile
Request additional information if documentation is incompleteprocessProfile
Determine authorization decisionprocessProfile
Record decision and generate authorization numberprocessProfile
Notify submitter of the final decisionprocessProfile

How AGI delivers it

Four ways AGI delivers for Manage pre-authorizations

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
Business-as-Code
Encode how your work runs, once, as software that executes itself.
Platform.do

Value flow

How Manage pre-authorizations connects

automated by

Apply Clinical Criteriamodel
Check Coverage Eligibilitymodel
Route Authorization Requestmodel
Submit Prior Authorization Requestmodel
Track Approval Statusmodel
Verify Eligibilitymodel
Prior Authorization Softwaremodel
Prior Authorization Systemmodel
Utilization Management Platformmodel
Utilization Management Platformsmodel

Go deeper

Explore Manage pre-authorizations

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