AI Prior Authorization Automation: Speed Up PA Approvals
From eligibility check to a submission-ready PA package, Asepha automates every step between a new specialty prescription and an approved authorization. Build pre-filled PA packages from claim rejections, score approval probability, and automate your high-volume benefit verification and prior authorization calls.
calls successfully handled without human intervention
42 min
average time saved per case
Automatic Package Creation
When a claim comes back requiring authorization, Asepha reads the rejection code, identifies the PA requirements for that drug and plan, and begins building the package automatically. Clinical data in your system is pulled and mapped to the specific questionnaire fields required by that payer, laying the groundwork for you.
Before any PA is submitted, Asepha calculates the probability of approval based on the patient's clinical profile mapped against that payer's known requirements for the specific drug and BIN/PCN combination. Cases below your confidence threshold are flagged for review before submission instead of finding out after denial.
Behind Asepha is a knowledge graph that encodes payor rules, plan nuances, program criteria, and insights from real-world calls and data partnerships. This allows the system to decide which number to call, what questions to ask, and which details matter for a given benefit or prior authorization scenario. Results are logged directly to your work queue. When a PA is approved, expiring, or still pending, your team sees it and doesn't spend time chasing.
PA cases can be assigned to individual team members with aging flags and SLA alerts. Aging cases, high-risk drugs, and time-sensitive programs rise to the top automatically. High-confidence cases can be reviewed in batch.
