AI Automation
Prior-Auth Intake Agent for a Clinic Network
An agent reads referrals, pulls payer rules, drafts auth packets, and flags exceptions for clinicians — cutting days of back-and-forth into a governed queue.
Cover imagery illustrates the project category.
- Client
- Multi-site clinic network (confidential)
- Timeline
- 6-week MVP · payer-rule expansion after
- Our role
- AI agents & workflow partner
- 62%
- Less staff time on auth prep
- 6 wks
- Intake agent MVP live
- 100%
- Human sign-off before submit
The challenge
Prior authorization ate staff hours. Referrals arrived as PDFs; payer rules lived in tribal knowledge; incomplete packets bounced for days.
Our approach
We shipped an agent that classifies referrals, retrieves payer rules, drafts auth packets, and scores completeness before human review.
Tool permissions stayed narrow — draft only, never submit without sign-off.
What shipped
Concrete scope included in this engagement.
- 1 Referral ingest and classification
- 2 Payer-rule retrieval with citations
- 3 Auth packet drafting
- 4 Completeness scoring and exceptions
- 5 Audit trail and clinician review
The result
Staff time on auth prep dropped about 62%. Packets moved into a predictable queue with clear exceptions.
Stack
Need a similar outcome?
Tell us your constraints — we’ll map a realistic path.