Prior authorization, done in hours - not days

Enterprise-grade AI that slashes prior auth cycle times, cuts denials, and reduces operational cost across your network.

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See how the workflow runs→

Lift administrative burden with fewer clicks and less typing

Catch missing documentation before submission, not after

Reduce repeat AIR cycles and speed up time to care

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Prior Authorization

Why prior auth keeps slowing care?

elsai transforms ad hoc, manual work into governed, agentic workflows that deliver consistent outcomes.

80–90% of PA requirement checks are still manual and payer specific

20–40% of PA packets go out incomplete or misaligned to policy

30–50% of cases receive at least one AIR, adding 2–5 days per cycle

Clinicians and nurses face repeated chart reviews and documentation requests.

See how elsai changes this →

How does the elsai PA agent run your workflow?

Step 01

Trigger

Detects new orders or PA tasks in your EHR/RCM and directs them to the appropriate PA flow.

Step 02

Gather

Pulls orders, eligibility, benefits, policies, notes, labs, imaging, and history from systems and payers.

Step 03

Decide

Determines if PA is needed, checks packet completeness and policy alignment, and identifies remaining gaps with configurable confidence thresholds and real-time support.

Step 04

Assemble

Creates payer-ready forms and documentation for quick review and approval.

Step 05

Track

Tracks payer status and deadlines, alerts the team of impending SLA risks, and maintains an audit trail across decisions and AIR cycles.

Watch a sample intake flow →

Agentic AI orchestration for prior authorization

The elsai PA Agent orchestrates specialized AI agents to automate your prior authorization workflow, from requirement determination to documentation and AIR handling, with efficient routing and human-in-the-loop oversight.

Requirement determination agent

Evaluates new orders using payer specific rules, historical outcomes, and medical policy intelligence to decide if PA is required and which path to follow.

Requirement determination agent

Evaluates new orders using payer specific rules, historical outcomes, and medical policy intelligence to decide if PA is required and which path to follow.

Document completeness agent

Finds and reads clinical documents, compares against payer checklists, and scores packet readiness so gaps are fixed before submission.

Document completeness agent

Finds and reads clinical documents, compares against payer checklists, and scores packet readiness so gaps are fixed before submission.

AIR handling agent

Interprets vague AIR letters, pinpoints exact documentation gaps, and assembles targeted response packets that reduce repeat AIR cycles and denials.

AIR handling agent

Interprets vague AIR letters, pinpoints exact documentation gaps, and assembles targeted response packets that reduce repeat AIR cycles and denials.

Campaign Performance

Last 30 Days

↑ 12.4%

ROI

Q3 Customer Support

2 variants • 45k runs

↑ 12.4%

ROI

Active

98% Success

Sales Outreach Bot

1 variant • 12k runs

Active

98% Success

Governance line: All agents are governed by ARMS. Every action is logged, explainable, and bounded by guardrails and mandatory human review on low confidence cases.

Provider‑first, EHR‑integrated PA automation

You don't need to replace systems or workflows; the agents integrate with your existing tools and deliver results in your teams' familiar interfaces.

Systems

Connects to EHR and practice management for orders, scheduling, and documentation.

Integrates with your RCM tools, payer portals, phone, and fax-to-PDF workflows.

Sends determinations, auth numbers, AIR notes, and status updates to keep teams within their existing systems.

Users

PA nurses and coordinators

Revenue cycle and patient access teams

Service line and clinical operations leaders

Discuss your EHR/payer links →

Less admin work. Faster, safer decisions.

Faster decisions

Real-time PA checks and minutes to "packet-ready" for quicker care.

Fewer denials & AIRs

Address missing info and weak documentation before submission; provide targeted responses to payers' requests.

Less burnout

Staff focuses on exceptions, sending clinicians targeted, concise requests instead of vague "justify" messages.

Better patient access

Fewer last-minute cancellations and delays.

Full audit trails for every decision, packet, and AIR response

Explainable logs tied to rules, policies, and evidence

Policy-based guardrails, automation thresholds, and human review controls

See ARMS and reporting →

Start small. Prove it. Expand

Begin with one area, measure the impact, then scale to more service lines or payers.

Review and choose

Identify one or two high-volume service lines or payers where delays hit hardest.

Connect and configure

Link your EHR, queues, and payer systems; define automation rules and review points.

Pilot and refine

Test with real cases, assess results, then expand as confidence grows.

Frequently asked questions

Frequently asked questions

Questions teams ask before they turn PA agentic

Does this replace our EHR or current PA tools?

No. The elsai PA Agent sits on top of your EHR, RCM systems, and payer connections. Your core platforms remain the source of truth - ELSAI orchestrates requirement checks, completeness, and AIR handling across them.

Does this replace our EHR or current PA tools?

Do we have to change our workflows?

Not dramatically. You can submit and track authorizations from the systems and channels you use today; elsai automates the heavy lifting behind the scenes.

Do we have to change our workflows?

Not dramatically. You can submit and track authorizations from the systems and channels you use today; elsai automates the heavy lifting behind the scenes.

Can we control automation vs. review?

Yes. You set automation thresholds, guardrails, and specify which cases always require human review. The system routes only high-confidence cases for straight-through processing, giving you control over automation and review processes.

Can we control automation vs. review?

How fast can we start?

Organizations typically start with a pilot in one service line or payer to demonstrate value before expanding to additional lines, ensuring a smooth deployment process.

How fast can we start?

Organizations typically start with a pilot in one service line or payer to demonstrate value before expanding to additional lines, ensuring a smooth deployment process.

Is PHI protected?

Yes. elsai operates in a secure, HIPAA-aligned environment with encryption, role-based access controls, and comprehensive audit logging, ensuring PHI remains protected and your data security is maintained.

Is PHI protected?

Ready to make prior authorization truly provider first?

Let's review your PA workflow to identify how the elsai PA Agent can automate checks, close documentation gaps, and manage AIRs within your current systems.

Book a PA agent demo →

Talk to our team →

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