AI-powered Prior Authorization Navigator

Prior authorization (PA) is a critical but time-consuming process in healthcare. Physicians spend an average of 13 hours per week on PAs, with each manual request costing $14.49. Worse, 80.7% of appeals are overturned, highlighting inefficiencies in the current system.

An automated prior authorization navigator changes everything. Powered by Hexaware’s Tensai® and Agentverse^TM, this innovative tool compares clinical evidence with payer requirements and runs clinical documentation gap analysis before submission. Automating policy mapping and generating draft medical-necessity letters ensures faster, more accurate submissions.

How It Works:

1. Case Input: Upload patient information, diagnosis codes (ICD-10), and procedure codes (CPT).
2. Reasoning: AI analyzes policy compliance and identifies gaps.
3. Grounding: Updated payer policies are retrieved for validation.
4. Output: Receive a readiness score, actionable insights, and draft letters.

With built-in guardrails to validate inputs and outputs and assess policy applicability, our solution ensures compliant submissions, reduces denials, and improves patient outcomes.

Transform your prior authorization process today with Hexaware.