Welcome to an Enhanced Prior Authorization Management Platform
NSF‑backed innovation: Adaptive AI + human‑in‑the‑loop to cut coordinator time from hours to minutes.
Adaptive AI model
Continuously learns from policy updates using reinforcement learning and real‑time data ingestion. Always current with new forms and regulations.
AI‑assisted decision support
Integrates clinician feedback loops for iterative improvements. Staff can review and adjust recommendations before submission.
Operational KPIs
Time to submit, manual corrections per PA, first‑time approval rate, and submissions per staff/day with trend context.
Part B Infusions
50% of cases
Part D Oral
Pharmacy routing
Imaging
46% of cases
Genetic Testing
1% of cases
Surgery
3% of cases
Medicare Advantage
89
PAs this month
Traditional Medicare
108
PAs this month
BCBS
66
High friction payer
Commercial Payers
25
UHC, Cigna, Aetna
Work Queue
Daily M-F morning review
Workflow Integration
Auto-populate from EMR
Form Review
Side-by-side evidence review
Portal Integration Status
95% portal submissions
UHC/Optum
Primary portal • Daily checks
Carelon
Anthem BCBS portal
Availity
Multi-payer clearinghouse
Top Denial Prevention
Address before submission
Lack of Documentation
Staging, prior lines, biomarkers missing
Criteria Not Met
NCCN guidelines verification needed
Duplicate Authorization
Another scan already approved
P2P Alert: Teams notification sent to MD for peer-to-peer scheduling