- An agent gathers the chart documentation for an order, matches it to the payer's published criteria and drafts the prior-authorization request with each source cited.
- H2O Document AI reads faxed referrals, orders and prior-authorization packets and returns the fields your team keys by hand today.
- Nothing reaches a payer until a person on your team approves it, and the payer makes every coverage decision.
- The first run is shadow mode on last quarter's requests, so you see how close each draft is before it touches a live case.
Every prior authorization is assembled by hand
Your prior-authorization team reads an order, opens the chart, finds the notes, results and history that support medical necessity, and checks them against the payer's criteria. Then they fill in the payer's form or portal, attach the documents and track the answer.
Each payer asks for something slightly different, and the criteria change. What slows care down is the labor of assembling proof, one request at a time, while the patient waits. A request that goes out incomplete comes back as a pend, a denial or a phone call, so the work is not only slow, it is repeated.
How prior authorization automation works
Generative AI reads documents and drafts text, and H2O AI Super Agent carries the work across the systems you connect, with a person approving each step that matters.
Step 1: detect the need
An order arrives from your record or scheduling system. The agent checks it against the payer rules you maintain and flags the ones that need a prior authorization.
Step 2: read the documents
H2O Document AI reads referrals, orders and outside records with intelligent character recognition and returns patient, provider, service, codes and dates as structured fields.
Step 3: gather the evidence
The agent pulls the relevant notes, results and history from the systems you connect, and retrieves the payer's criteria from a collection you keep current, with a reference to the source behind every passage.
Step 4: draft the request
The agent fills the payer's form and writes the medical-necessity summary from the chart, with the criterion and the supporting document cited next to each point. A missing item is listed, not guessed.
Step 5: review and submit
A person on your team edits, approves and submits the request through your existing portal or process. The agent stops at an approval gate and submits nothing on its own.
Step 6: track the answer
The agent records the payer's response, flags pends and requests for more information, and routes a denial to your appeals team.
Where prior authorization meets denials
A request that goes out incomplete often comes back later as a denial. A complete, cited request up front is cheaper than an appeal after the fact.
Proof
H2O can be used to read referrals and prior-authorization documents, assemble the packet against the payer's criteria, and draft the request for your staff to review and submit. No customer result is published for prior authorization yet, so a pilot starts by measuring your own baseline.