Prior Authorization Submission for Prior Authorization Specialists with Availity
The Problem
Prior auths for Utilization Management procedures sit in CoverMyMeds queues for days — the patient reschedules, the surgeon's OR time goes unused, and the practice eats the margin.
What We Build in Availity
AI checks payer-specific PA requirements, pulls the chart from CoverMyMeds, submits the PA with clinical justification, and tracks status — turnaround drops from 7 days to under 48 hours. Purpose-built for teams running Availity — uses the native API or agent integration so nothing leaves the system of record.
Availity Integration Approach
Audit your Availity configuration
We map the specific Availity objects, custom fields, and workflows the automation needs to touch for your utilization management practice.
Build on the Availity API or agent
Integration happens inside Availity — no data leaves the system, no parallel tool for your team to learn, no license changes.
Human-in-the-loop handoff
Every automation routes exceptions back to a human in Availity with enough context to act — AI handles the 80%, your team owns the judgment calls.
See this running in your Availity instance
30-minute call. We'll look at your actual Availity setup and show exactly how this workflow fits.