Insurance Verification Automation
12 hours/week → 30 minutes
Automated eligibility checks, prior auth submission, and appeal generation for a regional healthcare provider. 8-week payback.
Results
Weekly time on verification
12 hours → 30 minutes
Prior auth approval rate
+22% improvement
Staff time redirected
3 FTE hours/day → high-value care coordination
ROI payback
8 weeks
The Challenge
A regional healthcare provider with 12 clinics was spending 3 FTE hours daily on insurance eligibility verification and prior authorization. Staff morale was low — the work was tedious, error-prone, and high-stakes.
The Solution
We deployed a three-agent pipeline: an eligibility agent that queries payer APIs and structures the response, a criteria-matching agent that checks ICD-10 codes against payer coverage rules, and a submission agent that prepares and submits the authorization request. Human review gates at submission and appeal stages ensure accountability.
Timeline
6 weeks
Tech Stack
Want results like these for your operation?
Start with a 30-minute scope call. We'll define the baseline and project the ROI before any code is written.