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.
How we delivered it.
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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11th Floor, Prestige Tech Park, Platina 2 · Outer Ring Rd, Kadubeesanahalli · Bengaluru, Karnataka 560087, India
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PLOT B6-1628, SECTOR-10, CDA · Cuttack, Odisha 753014 · India
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