AI-Powered Prior Authorization Management
Get every authorization approved before it delays care.
BlackBook 2026 #1 : AI-Powered Claims Automation (9.67/10)
89%
Approval odds pre-submission
62%
Overturn via P2P under 30 days
71%
Of auths, zero human touch
AI that works every authorization end to end from pre-visit requirement detection to clinical packet assembly to peer-to-peer and appeal. The payer's clock starts. So do your agents.
The Prior Auth Crisis
Authorization rules keep multiplying. Your clinical staff keeps making the calls.
Almost every denied authorization was approvable. The criteria were met, or could have been, before anything was submitted. What's missing is the time to read the policy, the data to know which document is absent, and the payer-specific expertise to argue it inside the 72 hours CMS gives you.
1/4
of practices report an authorization delay that led to a serious adverse event. The clock is a clinical problem.
3/4
of denied authorizations are never appealed. Not unappealable. Just unstaffed.
How Rapid Prior Auth works
Detect. Assemble. Submit. Overturn. Prevent.
Detect & Verify
Every requirement known before the visit is booked. Every rule sourced.
Enter a payer and a CPT or J-code, or let the scheduled order trigger it. Rapid Prior Auth resolves the requirement through the payer rules KB, FHIR CRD, your prior-PA cache and a portal scrape, naming the delegation, criteria set, documents and submission window. No portal hunting.
98% detection confidence · Payer rules KB → FHIR CRD → portal scrape
Assemble & Close Gaps
Every criterion checked. Every gap named before submission.
Agents pull clinicals from the EHR against the payer's own document list and score the packet line by line: met, partial, missing. Approval blockers surface with the odds delta attached, so you see 41% become 89% before anything reaches the payer. Only cases needing judgment reach a human.
41% → 89% odds after blockers cleared · MCG + payer medical policy scoring
Submit & Track
Every submission on the payer's channel. Every clock watched.
Submission goes out over X12 278 or portal RPA, whichever the payer honors. Polling is deadline-aware, and determinations from fax, portal and 278 land on one status timeline with the cited policy attached. Nobody sits on hold waiting for a status.
CMS-0057: 72h expedited / 7d standard · 278 + portal RPA + voice IVR
Escalate & Overturn
Every denial routed to the path that actually wins.
Each denial is classified clinical or procedural before anything is filed. Clinical denials go to peer-to-peer first; procedural denials go straight to a Level 1 appeal. The prep packet arrives with talking points, the denial rationale and the cited NCD/LCD, and the full appeal ladder is tracked.
58 to 65% P2P overturn · Clinical vs. procedural routing
Prevent & Compound
Every determination teaches the next authorization.
Every approval, denial and cited policy writes back to the rules KB and prior-PA cache, so the next identical order arrives with the document list that worked last time. Criteria intelligence flows to RapidCode and RapidRecovery. The loop closes on the encounter before it happens.
Prior-PA cache reuse · Integrated with RapidCode + RapidRecovery
Results
What our customers recover.
89%
First-pass approval after blocker resolution Large Health System · 240K auths/year
$3.2M
Procedure revenue protected in 12 months Multi-Specialty Group · 48K auths/year
71%
Of authorizations closed with no human touch Community Health Center Network
Why RapidPriorAuth
Not another authorization portal. A complete approval engine.
Your odds are 41%. We'd rather tell you that now than after the denial.
Pre-Submission Blocker Resolution
Every other tool submits, waits, then works the denial. Rapid Prior Auth scores the packet against the payer's own medical policy before submission and names the missing documents with the odds delta attached. Each resolved blocker writes back to the rules KB.
41% → 89% odds · Blockers named pre-submission
Your agents gather the clinicals. Your staff just signs off.
Agentic Packet Assembly
Assembly is where the hours go: staff digging through the chart for films, notes and prior trials. Agents retrieve from the EHR against the payer's document list, assemble the packet, and surface only the cases where a human decision is genuinely required.
EHR-native retrieval · Human review only where required
Not a template letter. The payer's own policy, turned back on them.
Payer-Specific Appeal Drafting
Most appeals are one letter with the codes swapped. Drafts here are templated by denial reason, service and payer, citing the payer's own medical policy, the applicable NCD/LCD and a new-evidence checklist. Every determination sharpens the library.
Denial reason × service × payer · Cites payer's own policy
Your worklist ranks itself. By what's actually at stake.
Expected-Value Prioritization
Most queues sort by date, which puts a $540 DME request above $45,000 of spine surgery two days from its deadline. Every authorization carries an EV score: stage risk × dollars at risk × urgency, with deadline proximity and expedited flags folded in.
Stage risk × $ at risk × urgency · CMS deadlines on a clock
Purpose-Built
Built for your organization
FQHCstrust RapidClaims
FQHCs
Sliding-fee and 340B documentation held to payer criteria on every request. Protect visit and procedure revenue across Medicaid MCO authorizations.
Community Health Centers
Medicaid MCO rules and state turnaround SLAs tracked payer by payer. Fewer procedures rescheduled for paperwork.
Accountable Care Orgs
Utilization tracked against total-cost-of-care targets, not just approvals. One layer across every practice.
Physician Groups
Gold-carding thresholds and specialty criteria tracked as payers revise them. Your front desk keeps its workflow.
Hospitals and Health Systems
CMS-0057 and state turnaround mandates on a visible clock. Protect high-dollar surgical, infusion and imaging revenue pre-service.
Don't see your org type?
Get in touch with our team
If you manage authorizations at scale, Rapid Prior Auth can help. Tell us how your team works.
Talk to us
Approved before the visit. Paid after it.
Rapid Prior Auth works alongside RapidRecovery™ and RapidCode™. Post-service denials open with the authorization record attached, and documentation is tuned to what the payer approves.
BlackBook 2026 #1 : AI-Powered Claims Automation (9.7/10)
Frost & Sullivan 2025 : Technology Innovation Leader
BlackBook 2025 #1 : AI-Powered Claims Automation (9.61/10)
Works with your existing systems.
RapidPriorAuth integrates with your EHR and billing system over X12 278, FHIR PAS and CRD, payer portals and fax. No rip-and-replace. No workflow disruption.
