Shift Agents · Prior Auth
AI prior authorization that submits complete, and chases every auth to a decision.
The Prior Auth Agent knows when a procedure needs an authorization, gathers what the payer wants from the chart and from outside offices, submits it complete, and follows it all the way to a decision. When a date moves, it keeps the auth valid, and it makes sure the auth number reaches the claim.
Priya S. · Lumbar MRI
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Insurance Verification Agent
Verifying coverage…
Active. Auth required for lumbar MRI.
Coverage verified: auth required.
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Prior Auth Agent
PT notes aren’t in the chart.
Requested from the therapy clinic…
8 weeks received. Submitted with notes attached.
Memory: This payer wants 6 weeks of PT documented for lumbar MRI.
Auth approved Wed: #A6190.
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Scheduling Agent
Thu 2:00pm held while the auth was pending.
Confirming with Priya by text…
Procedure scheduled: Thu 2:00pm.
What it does
What it does with every authorization
Knows when it’s needed
From the plan and the procedure, before scheduling.
Builds the packet
From the chart, and from outside offices when notes are missing.
Submits it complete
With what this payer is known to ask for.
Follows it to a decision
Instead of waiting for someone to check the portal.
Keeps it valid
Extends the auth when the date moves, and attaches it to the claim.
Where it works
One agent, two places it saves you money.
The line it won’t cross
It never writes around a gap.
Never fabricates a clinical justification. If the chart doesn’t support medical necessity, it says so.
It drafts from what the chart shows, names what’s missing, and asks for it, instead of improving the odds with words the record doesn’t back.
See every agent’s guardrails →How it connects
Works inside the systems you already run.
Your EHR / PM
Reads and writes in the systems your team already uses.
- athenahealth
- NextGen
- AdvancedMD
- eClinicalWorks
- Greenway
- ModMed
- SIS
Payers
Submits and checks status by API where available, and through payer portals with Browser Agents where not.
Outside offices
Requests missing notes from referring and therapy offices.
Questions
Prior Auth Agent, answered.
How does it know what a payer will ask for?
It remembers what each payer has required before, such as six weeks of physical therapy for a lumbar MRI, and gathers it up front so the first submission is complete.
What if the documentation doesn’t support the request?
It says so. It drafts from what the chart shows, names the gap, and asks the right office for the missing records. It never writes a justification the chart doesn’t support.
What happens when the procedure date changes?
It checks the auth window before the date moves and extends the auth with the payer when it needs to, so a reschedule doesn’t void it.
Does it work with our EHR?
It works with athenahealth, NextGen, AdvancedMD, eClinicalWorks, Greenway, ModMed and SIS, using APIs where they exist and Browser Agents where they don’t.
How is patient data protected?
Every customer gets a BAA, data is encrypted in transit and at rest, and each agent sees only what its task needs. Every action is logged with its reason.
Works alongside
Referral Agent →
AI referral management that turns every referral into a scheduled procedure.
Insurance Verification Agent →
AI insurance verification that catches coverage problems before the visit.
Denial Management Agent →
AI denial management that works every denied claim before the filing limit.
See the Prior Auth Agent work a week like yours.
20 minutes, with Lance Rodela, founder.