Learn how Alex, the Prior Authorization Agent, automates the entire auth submission process — from payer requirement lookup to approval tracking.
When a new patient is added or a plan of care is created, Alex automatically checks whether the patient's payer requires prior authorization for the prescribed services. Alex maintains a database of 2,000+ payer-specific authorization rules, updated weekly.
Alex gathers all required clinical documentation — diagnosis codes, treatment plans, functional limitation reports, and supporting notes — and assembles them into the payer's preferred format. This eliminates the manual process of hunting through charts for supporting documents.
Alex submits the authorization request through the payer's preferred channel (electronic portal, fax, or phone). Each submission is tracked with a unique reference number, and Alex monitors the status daily, escalating to your team only when human intervention is needed.
When an authorization is approved, Alex records the approved visits, date range, and any restrictions. As patients approach their visit limit or expiration date, Alex proactively initiates renewal requests — typically 5-7 visits before the limit is reached.
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