AI Agent spotlight: How Authorizations Agents contribute to a stronger revenue cycle

Authorizations are a critical part of a health system’s revenue cycle. They ensure that services are approved by payers before they’re delivered, directly impacting reimbursement. Without proper prior authorizations, claims can be denied, revenue can be lost or delayed, and your staff can end up with increased administrative burden to appeal denials. 

Effective authorization workflows help healthcare organizations ensure timely reimbursement, prevent denials, and reduce delays in care delivery, supporting financial stability, operational efficiency, and patient satisfaction. To achieve this, healthcare leaders are turning to automation.

Streamlining prior authorizations 

AI Agents—digital workers who can think, learn, and adapt as they carry out automated tasks—are creating efficiencies across healthcare organizations, from HCC form completion to payer operations. Healthcare organizations can use AI Agents to transform authorizations, too.

An Authorizations AI Agent can help streamline the process of both non-clinical and clinical authorizations: 

• End-to-end automation of non-clinical authorizations: The Intelligent Agent can transform your straightforward, non-clinical authorizations for standard procedures, routine referrals, or services with minimal medical necessity criteria by submitting and tracking them end-to-end with real-time EHR updates. The Agent supports submissions through APIs, 278 transactions, payer portals, and faxes, and seamlessly integrates existing workflows throughout the entire authorization process, from referrals to post-authorization scheduling. In these straightforward instances, AI makes in-scope authorizations a completely touchless experience for your team. 
• Acceleration of clinical authorizations: For more complex authorizations that require a clinical justification before approval, such as surgeries, advanced imaging, or specialty treatments, the Authorizations AI Assistant tool supports and streamlines the authorization by synthesizing structured and unstructured data to compile the necessary documentation to assist your staff in submitting the authorization. This includes streamlining responses to payer questions and analyzing data to generate clinical documentation packets. AI-powered assistance in these areas can reduce staff workload by over 50% and ensure accurate responses to payer questions, reducing denials.

Benefits of using an AI Agent for Authorizations

Using an Authorizations AI Agent can transform your revenue cycle. Key benefits of automating authorizations include: 

• Faster turnaround times: Organizations using the Authorizations Agent have achieved up to 3x productivity gains, helping more patients receive timely care. 
• Reduced denials and revenue loss: Accurate and timely submission of prior authorizations helps prevent claim denials due to missing or delayed approvals, which is one of the leading causes of revenue leakage in healthcare organizations. Organizations using the Authorizations Agent have cut auth-related denials by 25-50%. 
• Decreased administrative costs: Automating manual tasks reduces the need for staff time spent on submissions, follow-ups, and manual tracking, leading to significant labor cost savings. 
• Accelerated cash flow: Faster authorization turnaround time means services can be scheduled and billed more quickly, shortening the overall revenue cycle and improving financial predictability. 

Together, these improvements help minimize revenue leakage, increase operational efficiency, and create a more resilient and sustainable revenue cycle, making the Authorizations AI Agent a handy digital worker for any healthcare organization.  

Learn more about getting started with automating prior authorizations here.