AI-Powered Healthcare Prior Authorization Agent
AI-driven customer support automation delivers 24/7 assistance, reduces response time by 60%, and streamlines ticket routing and knowledge-based support.
Business Process Challenges
- Managed a high volume of prior authorization requests across healthcare services and insurance payers.
- Relied heavily on manual coordination between healthcare providers, administrative teams, and payers.
- Teams manually collected patient information and clinical documentation.
- Required manual document review and validation against authorization requirements.
- Authorization requests were manually submitted, tracked, and followed up with payers.
- Increasing request volumes led to processing delays and repetitive administrative work.
- Incomplete documentation created additional rework and authorization delays.
- Limited visibility made it difficult to track authorization progress across the full lifecycle.
- The organization needed to automate routine activities while keeping healthcare professionals involved in critical decisions.
- The goal was to improve request completeness, accuracy, payer communication, processing speed, and end-to-end visibility.
Our Strategic Approach
- Designed an AI-powered prior authorization solution using Microsoft Power Platform and AI agents.
- Created a centralized Power Apps interface for authorization teams to create, review, and manage requests.
- Used Microsoft Dataverse for centralized authorization data management.
- Implemented an Authorization Intake Agent to capture and validate authorization requests.
- Introduced a Document Verification Agent to extract information from submitted documents and identify missing requirements.
- Implemented a Payer Communication Agent to assist with payer correspondence and status requests.
- Added an Approval Tracking Agent to monitor authorization progress, deadlines, and pending actions.
- Implemented an Escalation Agent to identify delayed or high-priority cases and trigger appropriate workflows.
- Used Power Automate to orchestrate approvals, notifications, payer follow-ups, escalations, and status updates.
- Leveraged AI Builder and Copilot capabilities for intelligent document processing and user assistance.
- Used Power BI to provide operational and executive dashboards covering authorization volumes, turnaround times, pending requests, and process bottlenecks.
Our Engineering & Delivery Process
Our structured project delivery approach takes you from discovery and planning to development, testing, and deployment, ensuring quality, transparency, and predictable outcomes at every stage.
Discovery & Architecture
Deep-dive technical audit of existing systems, security baselines, API mapping, and comprehensive cloud target blueprinting.
UX & System Prototyping
Role-based user journeys, wireframing, high-fidelity clickable Figma prototypes, and API contract specifications prior to build.
Agile Sprint Engineering
Modular development sprints delivering clean, shippable code with automated CI/CD pipelines and continuous testing.
QA & Security Hardening
End-to-end regression suites, cross-device verification, load stress audits, and penetration testing for enterprise resilience.
Production Launch & Scale
Zero-downtime blue-green production deployment, real-time telemetry, administrator training runbooks, and ongoing SLA support.
Explore the Solution Through visuals
What changed for the client.
- Transformed prior authorization from a manual and reactive process into an intelligent, proactive workflow.
- Reduced repetitive administrative activities through workflow automation.
- Improved identification of incomplete requests and missing documentation using AI-assisted validation.
- Enabled teams to track authorization progress and respond more effectively to stalled or high-priority cases.
- Accelerated authorization turnaround through automated payer follow-ups and status updates.
- Improved request completeness and accuracy through AI-powered document validation.
- Provided real-time visibility across authorization pipelines and pending requests.
- Implemented proactive SLA monitoring and escalation workflows to identify cases requiring attention earlier.
- Gave leadership greater visibility into payer-level trends, process bottlenecks, and workload patterns through Power BI.
- Established a scalable foundation for expanding AI-assisted automation across additional healthcare workflows.
The numbers behind the rollout.
The full integration layer.
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What we offer
Offices
Bengaluru
11th Floor, Prestige Tech Park, Platina 2 · Outer Ring Rd, Kadubeesanahalli · Bengaluru, Karnataka 560087, India
Cuttack
PLOT B6-1628, SECTOR-10, CDA · Cuttack, Odisha 753014 · India
San Francisco
San Francisco, CA 94108 · United States
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