Pre-authorisations complete on the first pass.
The agent reads claims, referrals and pre-authorisation documents, checks eligibility and codes, and requests missing reports before a person spends time on the case.
What comes in
- Claims
- Referrals
- Pre-authorisation documents
- Patient forms
Decisions it makes
- Code
- Complete
- Query
- Approve
- Refer
What comes in
- Claims
- Referrals
- Pre-authorisation documents
- Patient forms
What the agent does
- 1Reads the documents, handwritten notes included
- 2Checks eligibility and codes
- 3Compares the request with the referral
- 4Requests missing reports
Decisions it makes
- Code
- Complete
- Query
- Approve
- Refer
A fixed list you define. The agent picks one, or hands over.
A worked example
Claims, referrals and pre-authorisations, checked and coded.
Illustrative. In shadow mode, nothing executes until you switch the decision type on.
Arrives
A clinic uploads a pre-authorisation request: form, referral letter, quote.
Read
Reads the quote and the handwritten referral. Diagnosis code missing.
Look up
Checks the member’s eligibility and benefit limits.
Request
Asks the clinic for the diagnosis code. The clinic replies.
Decide
Complete and within limits. Suggests approve; a nurse reviewer confirms.
Writes to
Every connection also works as a tool the agent uses mid-case.
Claims platforms
Claims platforms · In and out
REST API and webhooks
Channels in · In and out
Direct database read/write
Always available · In and out
Hospital and payer systems through partners.
What we measure
Four numbers, measured on your cases.
Measured in shadow mode on your data, before anything is switched on.
Share of cases handled without a person
Error rate on those cases
Time saved
Cost per case
Talk to us about this process.
Thirty minutes on one process and its numbers. If it fits, the next step is Discovery or two weeks in shadow mode.