HealOS uses intelligent AI agents to extract data, submit authorizations, respond to payer requests, and track approvals, ensuring patients receive care faster while your team saves hours every day.
Prior authorization processes are overwhelming healthcare teams with manual work, payer portal submissions, constant status checks, and denial management. These tasks drain time, delay patient care, and cause major revenue loss.
| Challenge | Impact | HealOS Solution |
|---|---|---|
| Manual data collection & submission | Delays, errors, denials | Automated data extraction & submission |
| Constant payer portal monitoring | Care delays, staff burnout | 24/7 real-time status tracking |
| Incomplete documentation packets | Denials, appeals, revenue loss | AI-generated complete packets |
| Payer-specific rule complexity | Submission errors, rejections | Payer-specific rule compliance |
| Manual appeal preparation | Lost revenue, delayed care | Automated appeal generation |
End-to-end automation that handles the entire prior authorization workflow from data collection to approval tracking
HealOS extracts structured and unstructured data from EHRs, including procedure codes, clinical documentation, patient demographics, treatment history, and eligibility details. AI compiles all required information into complete, payer-specific authorization packets. Submissions are generated instantly without manual data entry.
HealOS intelligently determines the correct submission channel and sends requests automatically via API, 278 EDI, payer portals, fax, or hybrid workflows. Each request follows payer-specific rules, reducing submission errors and increasing approval speed.
For complex authorizations, AI reviews clinical notes to identify required medical necessity elements. The system ensures all documentation matches payer criteria, improving approval rates for high-acuity care.
When payers request clarification or additional records, AI analyzes patient charts, extracts relevant clinical details, generates accurate, compliant responses, and submits documentation instantly. This streamlines back-and-forth communication and prevents delays.
HealOS compiles complete documentation packets by gathering imaging reports, lab results, previous treatments, progress notes, and care plans. This ensures that every submission is complete, reducing denials from missing or incomplete data.
AI tracks clinical encounters and ongoing care needs. When renewals are required, the system automatically prepares and submits reauthorization requests to avoid treatment gaps.
HealOS continuously monitors authorization status across payer systems and updates the EHR with pending requests, approved authorizations, denials, additional information requests, and delayed cases. This gives staff full visibility into every authorization without time-consuming portal checks.
HealOS automatically identifies and removes duplicates, false positives, outdated entries, incomplete cases, and resolved tasks. This keeps workqueues clean, organized, and easy for RCM teams to manage.
HealOS integrates seamlessly into major EHR systems and extracts only the required information for submission packets, payer responses, appeal documents, and reauthorization requests. This minimizes manual work and ensures compliance with data handling standards.
AI stays updated with changing payer rules, submission requirements, and clinical criteria. Every authorization meets current guidelines, drastically reducing denials related to rule mismatches.
HealOS uses historical patterns, payer behavior, and clinical data to predict whether an authorization is likely to be approved. Providers can optimize submissions to improve initial approval rates.
For denied cases, AI analyzes denial reasons, identifies missing documentation, compiles supplemental evidence, prepares appeal letters, and submits appeals faster. This helps organizations recover lost revenue quickly.
HealOS connects to your EHR and pulls required details, diagnoses, procedure codes, imaging, progress notes, and eligibility data using advanced AI and OCR. No manual data entry, no searching through charts.
The system compiles all required clinical documentation into a structured, payer-specific packet. Missing fields, incomplete notes, or medical-necessity gaps are flagged instantly to prevent denials.
HealOS automatically determines the proper submission method API, 278 EDI, payer portal, or fax, ensuring every request meets payer rules and formatting requirements.
When payers ask for additional details, HealOS analyzes the chart and generates accurate, evidence-based responses. This eliminates back-and-forth delays and shortens review cycles.
Intelligent monitoring tracks payer portals continuously. Every update, pending, approved, RFI, and denied is synced back to your EHR in real time with zero manual follow-ups.
HealOS tracks ongoing care, expiration dates, and treatment changes. When reauthorization is needed, the system prepares and submits renewals automatically.
AI reviews denial reasons, gathers missing documentation, and drafts payer-ready appeal letters. This drastically increases overturn success rates and protects revenue.
Transform your prior authorization process with intelligent automation that improves financial performance, reduces errors, and enhances operational efficiency
AI processes prior authorization requests in minutes instead of days, reducing delays, improving patient access, and accelerating care delivery with fully automated workflows.
Automation eliminates manual data collection, payer portal submissions, and constant status checks cutting administrative workload by up to 80% and freeing staff for higher-value tasks.
AI creates complete, accurate, payer-specific submissions that reduce denials, prevent missing documentation errors, and significantly increase first-pass authorization approval rates.
Faster approvals lead to quicker billing, fewer write-offs, and stronger revenue cycle performance by ensuring every reimbursable service is properly authorized.
Automated prior authorization workflows reduce staffing needs, eliminate overtime, and support scalable operations without additional administrative resources or manual effort.
Orthopedics, cardiology, neurology, oncology, GI, pulmonology, and behavioral health clinics use AI automation to manage high authorization volumes.
Centralized PA management across multiple locations ensures consistent, high-accuracy submissions.
AI supports enterprise-level volumes, complex clinical cases, and multi-department workflows.
Teams eliminate manual workload and improve clean claims for downstream billing.
Organizations consistently achieve 91%+ clean submissions, 35–45% touchless automation, and significant FTE savings.
HealOS manages every stage: data extraction → submission → tracking → appeals.
Works with all major EHRs, PM systems, and payer portals.
With full HIPAA compliance, encryption, access control, and detailed audit logs, HealOS protects financial and patient data across all workflows.
"HealOS transformed our prior authorization workflow completely. We went from weeks of delays to same-day approvals. The 91% success rate and 80% reduction in administrative work has been game-changing. Our staff can finally focus on patient care instead of paperwork."
"The automated prior authorization system paid for itself in the first quarter. We're saving 15 minutes per submission and have eliminated our authorization backlog. The 55% reduction in write-offs has directly improved our bottom line."
"Prior authorization used to be our biggest bottleneck. With HealOS, over 40% of our authorizations are now touchless. The AI handles complex payer requirements flawlessly, and our approval rates have never been higher. This is the future of healthcare administration."
Everything you need to know about AI-powered Prior Authorization Automation
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