Automate Prior Authorization.
Increase Approval Speed.

Stop waiting on payers. Start getting authorizations approved. Our AI prior authorization software automates the entire authorization lifecycle by determining PA requirements, gathering clinical documentation, submitting requests, and tracking approvals in real time. Purpose-built to deliver prior authorization workflow automation end-to-end so your clinical and billing teams focus on patient care, not payer paperwork.

Consult Our Experts

The Cost of Manual Prior Authorization on Revenue Cycles

Hospital and RCM teams still manage prior authorization manually across payer portals, documentation workflows, and administrative queues. Staff spend hours assembling clinical documents, checking payer rules, faxing requests, tracking status updates, and following up on pending decisions. It slows care delivery and reimbursement timelines.

$35B

Annual Administrative Cost of Prior Authorization

Prior authorization accounts for $35 billion in annual US healthcare administrative spending. Hospital systems and RCM teams spend thousands of hours managing payer-specific authorization workflows, documentation requirements, and follow-up operations across multi-payer environments.

13 hrs

Staff Time Spent Per Provider Per Week on PA

The average medical practice completes nearly 40 prior authorizations per physician each week, with staff spending 13 hours managing payer paperwork, submissions, and follow-ups. Many organizations hire or reassign staff solely to manage growing authorization volume.

92%

Of Providers Report PA Delays Patient Care

Nearly all providers report prior authorization delays impacting care delivery and treatment scheduling. Many physicians report patients abandoning treatment due to approval delays and administrative bottlenecks across payer workflows.

AI-Powered Prior Authorization Automation

The Prior Authorization Agent isn’t a portal overlay or a fax-to-digital converter. It’s an AI-powered prior authorization workflows engine that autonomously determines PA requirements, assembles clinical evidence, matches medical necessity criteria, submits requests, and tracks decisions — your team shouldn’t have to chase payer approvals.

Detects prior authorization needs using payer, plan, CPT/HCPCS, and benefit rules in real time.

Pulls clinical documentation from the EHR automatically, including diagnoses, labs, imaging, and treatment notes.

Matches patient data against payer medical necessity and coverage rules, flagging documentation gaps early.

Submits PA requests through FHIR APIs, payer portals, clearinghouses, or fax automation in one workflow.

Continuously tracks PA status across payers and pushes real-time updates into the EHR.

Analyzes denials, auto-generates appeal letters, and routes peer-to-peer review requests.

Manual Prior Authorization

Staff manually verify if PA is needed

Hours collecting clinical documents

Manual status monitoring across payer portals

AI Prior Authorization

AI identifies PA needs in real time

NLP automatically extracts documentation from EHR

Multi-channel automated submission (FHIR, portal, fax)

Constant real-time status monitoring

AI Workflows for Prior Authorization

AI-powered workflows that automate coding validation, payer rule checks, eligibility verification, and claim accuracy review before submission across healthcare revenue cycle operations.

PA Requirement

Determines whether prior authorization is required using payer rules, CPT/HCPCS codes, benefit plans, and patient eligibility workflows in real time.

Clinical Documentation

Extracts clinical notes, labs, imaging, medication history, and treatment data from the EHR to assemble authorization-ready documentation automatically.

Medical Necessity Matching

Validates patient documentation against payer medical policies, InterQual, MCG guidelines, and coverage criteria before authorization submission workflows begin.

Submission & Routing

Submits authorization requests through FHIR APIs, payer portals, clearinghouses, and fax workflows while routing requests to the correct payer automatically.

Denial & Appeals

Analyzes denied authorizations, identifies root causes, and generates appeal-ready workflows with supporting clinical documentation and payer-specific requirements.

AI Agents Built for Revenue Cycle Teams

80% Reduction in Staff Time on Payer Calls

100% Automated Claim Status Tracking

Your Revenue Cycle, Running on Autopilot.

OSP's Agentic AI Revenue Engine automates the most repetitive task in your billing workflow — calling payers to check claim status. It makes the calls, captures the updates, and reports everything in real time, so your team spends zero time on hold.

What It Does:

Automatically calls payers to check claim status
Captures claim updates without any manual follow-up
Logs and reports claim status directly to an Excel sheet
Replaces hours of staff time spent on hold with payers

See It In Action

4x Faster Denial Resolution with AI

5x Reduction in Denial Management Workload

Stop Writing Off Denied Claims. Start Recovering Them.

OSP's RCM Revenue Engine pulls denied claims from any source — EHR, clearinghouse, or manual upload — uses AI to identify the root cause, determines the best course of action, and automates the entire resolution workflow.

What It Does

Identifies root cause of every denial using AI
Auto-generates appeal letters tailored to payer requirements
Resubmits claims or routes complex cases to staff
Tracks every denial from identification to resolution

See It In Action

95%+ First-Pass Clean Claim Rate

50% Reduction in Manual Claim Review

Every Claim Scrubbed Before It Leaves Your Office.

OSP's AI Claims Scrubbing Agent validates every claim before submission — checking coding accuracy, payer rules, NCCI edits, and eligibility in real time. It catches the errors, suggests the fixes, and routes clean claims to the payer.

What It Does

Automatically validates CPT, ICD-10, and HCPCS codes against payer-specific rules
Catches coding errors, missing modifiers, and bundling violations before submission
Verifies patient eligibility, prior auth, and COB in real time
Routes clean claims to payer and flags dirty claims with specific fix instructions

See It In Action

Solutions We Delivered

Claims Data Management Solutions

Built a cloud-based claims data management platform to centralize healthcare claims processing, improve data visibility, and streamline payer communication across distributed systems.

65%

Faster Claims Data Access

View Case Study

Transforming Billing for FQHC Clinics

Developed a secure, HIPAA-compliant claims management platform to automate billing, coding, reimbursement workflows, and denial tracking for a dental FQHC clinic.

KEY BILLING OUTCOMES IMPROVED

View Case Study

Automated Claim Review System

Developed an automated and cloud-based claim review system to identify errors and avoid long turn-around time.

100%

Error-free EORs

View Case Study

Mental Health PM+RCM Solution

Built a customized solution to improve revenue cycle and practice management workflows in a mental-health center.

55%

reduction in claims losses

View Case Study

For the Teams Running Real Revenue Cycles

Best fit for hospitals, RCM firms, specialty groups, and multi-location provider organizations managing high-volume prior authorization workflows across multi-payer environments.

RCM Firms & Billing Companies

Run more books with the same headcount. The Prior Authorization Agent handles the PA determination, documentation assembly, submission, and tracking work your analysts repeat every day — plugged into your existing tech stack. Improve operational margin consistency while scaling payer-specific authorization workloads.

Learn More

High-Volume Providers & Multi-Location Groups

Scale authorization throughput without scaling admin teams. Best for group practices, specialty chains, hospital networks with multi-payer environments where PA volume outpaces manual workflows. Reduce scheduling delays and authorization bottlenecks across enterprise clinical operations. Improve operational visibility, compliance readiness, and authorization throughput without increasing administrative headcount.

Learn More

Provider Revenue Cycle Teams

Reduce PA backlogs, improve first-pass approval rates, and relieve clinical staff of administrative burden — without adding headcount. AI healthcare admin automation that frees your team to focus on patient care, not payer paperwork.

Learn More

Hear From Our Clients

We've reached out and found companies like OSP to create our technology. This is my first time working with a company that has been so thorough. These guys are amazing. If you really are looking for someone for a technology solution, these guys are the real deal.

Stephen Carter

Co-Founder Home Health Pro

We approached OSP for a technology solution estimate and were impressed by their professionalism and clarity. Confident in their approach, we moved forward quickly. Their team stayed on schedule and within budget, providing regular updates. For future development needs, OSP will be our first choice.

Selita Jansen

Vice President Operations Health Solutions, LLC

Voi is dedicated to ending suicides globally with two solutions: Voi Detect, a validated suicide risk assessment, and Voi Reach, an AI-driven support app. OSP played a crucial role in transforming our concepts into commercially successful, award-winning solutions. I sincerely appreciate their invaluable support.

Rick Johnson

CEO, Voi Health

Frequently Asked Questions

In what ways can AI help achieve faster prior authorizations in revenue cycle management?

AI-driven prior authorization software supports the entire PA process life cycle including the identification of requirements, collecting clinical documentation, submitting the request through FHIR APIs, and tracking approvals in real-time. Staff recover 13 hours per week while first-pass approval rates reach 96%. Healthcare prior authorization AI eliminates the bottleneck between the order and the approval.

In what way can AI automate the detection and submission of prior authorizations?

The prior authorization workflow system utilizes automated analysis for each order’s CPT code and payer requirements. Once it determines that prior authorization is required on an order, the AI will request appropriate clinical documentation through your EHR system to see if all medical necessity criteria have been satisfied and automatically submit the request.

What impact does an AI enabled prior authorization system have on your overall approval rating for claims?

By using the AI-enabled prior authorization workflow to validate all of your supporting documents against the payer’s medical necessity criteria before submission, the risk of incomplete supporting documentation is significantly reduced. The average first-pass approval rate will be at least 96%. Implementation of the AI prior authorization denial prevention will help reduce your denial rate.

How is the AI-enabled system integrate with various EHR systems such as Epic, Cerner and others?

Compatible with native Epic and Cerner PA AI solution via bidirectional HL7/FHIR API integration; also, AthenaHealth, eClinicalWorks, NextGen, Meditech and others. Integration occurs directly within the user’s clinical workflow, with no external portal required.

What are some additional features included in AI prior authorization software?

AI authorization for healthcare includes capabilities such as real-time PA identification, NLP documentation, InterQual and MCG medical necessity matching, multi-modal application submissions, payer intelligence, appeals automation, and fully autonomous AI agents to comply with CMS-0057-F.

How is AI able to cut down on the costs involved in PA processes?

The average cost of administrative work related to PA comes to about $34,000 per year per physician. Automated PA processes reduce manual effort involved in preparing documents, monitoring the portals, and making phone calls. Automated AI-based healthcare administration brings back more than 700 hours per year for each physician.

How can AI help avoid denials from authorizations?

AI helps reduce prior authorization denials by validating documentation completeness and medical necessity requirements before submission. For denied requests, the system can automatically generate appeals with supporting clinical evidence.

How do the processes of AI prior authorization differ from manual or outsourced processes?

Manual PA takes 35+ minutes with 3+ staff per request. Outsourcing adds fees without EHR access. The AI prior authorization platform processes requests in under 90 seconds on average.

Is the prior authorization platform built on AI compliant with HIPAA (i.e., the Privacy Rule, Security Rule, etc.)?

The platform is designed to support HIPAA-compliant workflows through role-based access controls, audit trails, and PHI security safeguards. All patient health information is protected via a PHI-compliant AI prior authorization system that utilizes role-based access control, an audit trail and overall compliance with HIPAA specifications.

What are some of the best ways to find out more about AI prior authorization systems?

Organizations using AI prior authorization workflows have achieved first-pass authorization approval rates as high as 96%. We have an ROI model for automating AI prior authorization workflows, the CMS-0057F report on how authorization workflow has evolved and many more examples. Find all this at osplabs.com/insights.

What are some of the new trends in AI prior authorization?

AI prior authorization agents will replace traditional workflows, the CMS-0057-F ruling will accelerate the use of FHIR, gold carding will become prevalent in other states, and autonomous authorization workflows will manage end-to-end PA without human intervention.

How does the platform support human review and clinical oversight?

AI can automate documentation gathering, payer rule validation, submission workflows, and status tracking while supporting configurable human review for clinical approvals, peer-to-peer review, and exception handling workflows.

How does AI reduce prior authorization time?

AI automates requirement checks, clinical documentation gathering, payer submissions, status tracking, and workflow routing to reduce manual processing delays across high-volume prior authorization operations.

How does AI help prevent prior authorization denials?

AI validates documentation against payer-specific medical necessity rules, coverage policies, and authorization requirements before submission to reduce incomplete, inaccurate, or non-compliant authorization requests.

How does AI prior authorization work with Epic and Cerner?

The platform integrates with Epic, Cerner, and other EHR systems through HL7/FHIR APIs, payer connections, clearinghouses, and real-time authorization workflow synchronization.

Can AI automate prior authorization follow-ups?

AI continuously tracks authorization status across payer portals, APIs, and workflows while routing approvals, denials, and documentation requests back into operational queues automatically.

Does AI prior authorization support human review?

Yes. Prior authorization workflows support configurable human review for clinical approvals, peer-to-peer reviews, escalations, exception handling, and payer-specific authorization decisions where oversight is required.

Ready to Automate Prior Authorization?

Tell us about your RCM stack, PA volumes, and current authorization workflows. We’ll show you how AI prior authorization workflows reduce manual processing effort, accelerate approvals, and improve first-pass authorization rates across your payer environment.

30-minute live walkthrough using your procedure types and payer mix

ROI estimate based on your current PA volume and staff hours

Integration plan for your existing EHR and payer stack

CMS-0057-F compliance readiness assessment

Automate Prior Authorization. Increase Approval Speed.

The Cost of Manual Prior Authorization on Revenue Cycles

AI-Powered Prior Authorization Automation

Detects prior authorization needs using payer, plan, CPT/HCPCS, and benefit rules in real time.

Pulls clinical documentation from the EHR automatically, including diagnoses, labs, imaging, and treatment notes.

Matches patient data against payer medical necessity and coverage rules, flagging documentation gaps early.

Submits PA requests through FHIR APIs, payer portals, clearinghouses, or fax automation in one workflow.

Continuously tracks PA status across payers and pushes real-time updates into the EHR.

Analyzes denials, auto-generates appeal letters, and routes peer-to-peer review requests.

Manual Prior Authorization

AI Prior Authorization

AI Workflows for Prior Authorization

PA Requirement

Clinical Documentation

Medical Necessity Matching

Submission & Routing

Denial & Appeals

AI Agents Built for Revenue Cycle Teams

Your Revenue Cycle, Running on Autopilot.

What It Does:

Stop Writing Off Denied Claims. Start Recovering Them.

What It Does

Every Claim Scrubbed Before It Leaves Your Office.

What It Does

Reduce Authorization Costs with AI-Powered Automation

Works with What You Already Use.

Solutions We Delivered

Claims Data Management Solutions

Transforming Billing for FQHC Clinics

Automated Claim Review System

Mental Health PM+RCM Solution

Works With What You Already Use

For the Teams Running Real Revenue Cycles

RCM Firms & Billing Companies

High-Volume Providers & Multi-Location Groups

Provider Revenue Cycle Teams

Hear From Our Clients

Frequently Asked Questions

Ready to Automate Prior Authorization?

Connect With Us

Let’s Build Your Project

Automate Prior Authorization.
Increase Approval Speed.