Prior Authorization Automation demo
Every request read against the medical policy, each criterion shown met or not met with the page that proves it; the nurse decides. 1:15
What the demo shows
A clinical review solution for health plans that checks each request against medical policy.
Six agents read every page of the request the moment it arrives and tick each criterion of the medical policy with the passage that proves it; an open criterion becomes a pre-filled request to the provider for the exact missing document, and the nurse approves in one click when every box is ticked.
Transcript
- Prior Authorization Automation checks each request against the medical policy for health plan nurses.
- Nurses read up to 200 pages of request, and most appealed denials are later overturned.
- For Dolores Whitcomb's knee replacement, agents read all 186 pages in minutes.
- Each criterion is ticked with the passage that proves it, Grade 4 Arthritis, on page 41.
- One box stays open, no therapy notes, though page 14 says she went.
- One click makes it a pre-filled fax, asking for exactly that, six weeks of therapy notes.
- The notes arrive, the agents read them, and the last box ticks.
- Every box ticked, Renata approves in one click, decided on day three of seven, every page cited.
- Built on Botminds: agents, data, screens, and governance on one platform.
Transcribed from the film’s narration. Captions are on the player.