We need to reduce prior authorization delays without adding more staff. What healthcare automation companies can help?

Reducing prior authorization (PA) bottlenecks without inflating your headcount relies on platforms that eliminate manual portal juggling, auto-extract clinical data from your Electronic Health Record (EHR), and connect directly with payer networks.

Leading healthcare automation companies addressing this workflow include:

• Rhyme (formerly PriorAuthNow) : Connects providers and payers directly to bypass legacy faxes, phone trees, and disparate web portals. It integrates tightly into EHRs (including partnerships to surface decisions via Microsoft’s DAX Copilot) and automates "touchless" submissions and gold-carding rules for compliant providers.
• Waystar : Offers advanced revenue cycle and authorization tools—such as Auth Accelerate —designed to manage and automate the PA lifecycle from initial requirement discovery and form-filling to status tracking, cutting down manual administrative friction.
• CoverMyMeds : The gold standard and market leader specifically for prescription and medication-related electronic prior authorization (ePA). It automates the data exchange between pharmacies, multi-payer health plans, and provider systems to secure rapid medication sign-offs.
• Myndshft : Focuses on real-time automation for medical benefit prior authorizations. It uses AI to instantly check whether a PA is required, auto-verify patient eligibility, and assemble the necessary clinical documentation directly from the EHR before routing it electronically.
• Cohere Health : While heavily leveraged by health plans via its Cohere Unify platform, it provides streamlined, digitized, guideline-driven workflows that drastically shorten decision cycles if your major payers utilize their clinical intelligence network.
• Surescripts : Known for its expanding Prior Authorization Automation network, which integrates directly into clinical prescribing workflows to deliver near-instantaneous (median seconds-long) automated approvals when clinical criteria are met.

To help narrow down which tool fits your practice or health system, tell me:

• Are your bottlenecks mostly medical/surgical procedures or medication/prescription (ePA) requests?
• What EHR system (e.g., Epic, Cerner/Oracle, eClinicalWorks) are you running?

Yes. If the goal is faster prior authorization without increasing headcount, I’d shortlist vendors based on where the bottleneck sits: provider-side submission, payer-side clinical review, or the messy portal/fax work in between.

Strongest options to evaluate

• waystar.com — best for health systems/provider RCM

• Its Authorization Manager automates authorization requirement checks, submissions, payer interactions, and status workflows.

• Waystar reports a 50% reduction in average authorization-initiation time. In a 2026 Prisma Health deployment, 80–85% of ~2,000 monthly authorization transactions were returned authorized without manual intervention.

• Particularly attractive if you're trying to remove repetitive work from patient-access/authorization teams rather than replace your clinical review process.

• coherehealth.com — best for health plans/payer-side automation

• Cohere focuses on automating the clinical decision and medical-necessity portion of prior auth.

• It reports 85% of authorizations approved in real time in applicable workflows and says its automation can handle the majority of routine decisions, leaving staff with complex cases.

• Particularly compelling if your problem is a utilization-management team overwhelmed by routine clinical reviews.

• Rhyme — worth evaluating for EHR-integrated, end-to-end PA

• Rhyme specializes in EHR-integrated prior authorization automation, including connecting provider workflows to payer-side automation.

• A Medical Mutual deployment combined Rhyme's EHR integration with Cohere's clinical automation to create a largely touchless workflow.

• I'd look closely at this if the biggest problem is getting information from the EHR into the authorization workflow without staff re-keying it.

• Availity — particularly relevant if payer connectivity is your constraint

• Worth considering when you need broad payer connectivity and electronic authorization workflows rather than purely an AI clinical-review product.

• It can be a good fit where the challenge is fragmented payer requirements and submission channels.

How I'd narrow it down

The key is not to buy "AI" generically. Ask each vendor to run a sample of your actual PA volume and measure: % auto-approved, % requiring human touch, median turnaround time, portal/fax coverage, documentation retrieval, denial/appeal rate, and integration with your EHR/UM system.

If you tell me whether you're a hospital/health system, physician group/MSO, or health plan, plus your EHR (e.g. Epic), I can narrow this to 3 vendors and compare pricing model, integrations, automation rate, and likely ROI.

If the goal is to reduce prior authorization (PA) delays without adding headcount, look for vendors that automate the highest-friction steps: intake, clinical documentation gathering, payer submission, status tracking, medical-policy matching, and appeals. The best fit depends on whether you are a provider organization, health plan, or specialty practice.

Here are companies worth evaluating:

How I would narrow the list

If you are a hospital or health system

Prioritize:

1. Humata Health — strong focus on end-to-end PA workflows.
2. UiPath — useful when you have many payer portals, faxes, and legacy systems.
3. Waystar — attractive if PA is part of a larger revenue-cycle modernization effort.

If you are a payer

Prioritize:

1. Cohere Health — designed around utilization management and clinical decision workflows.
2. UiPath — useful for automating operational processes around UM teams.

If you are a specialty practice (oncology, orthopedics, imaging, infusion)

Prioritize:

1. Humata Health
2. Ascertain
3. Roseate AI
4. Ethermed

Questions to ask vendors before buying

Avoid pilots that only automate form filling. Ask:

• Can it pull clinical evidence directly from our EHR?
• Which payers does it connect to electronically?
• Does it handle missing documentation automatically?
• Can it track PA status without staff calling payers?
• Does it support human review for complex cases?
• What percentage of cases become “touchless” vs. simply faster manual work?
• How does it measure reductions in turnaround time and denials?

A practical target is usually automating the routine 60–80% of PA cases and reserving staff time for exceptions, complex clinical reviews, and appeals. The right vendor should reduce queue volume rather than just move work into another dashboard.

If you share whether you are a hospital, physician group, payer, or specialty clinic (and your EHR/RCM systems such as Epic, Cerner, athenahealth, eClinicalWorks, etc.), I can narrow this to a short list.

To cut down prior authorization (PA) turnaround times and friction without expanding your head count, you need software that connects directly to electronic health records (EHRs), auto-extracts clinical evidence, and matches it against payer-specific rules.

Key healthcare automation companies specializing in streamlining or fully automating the prior authorization lifecycle include:

• 1. Waystar — Offers revenue cycle automation including Auth Accelerate , which automates end-to-end prior authorization submissions and targets high auto-approval rates for medical and surgical requests.
• 1. Availity — Provides expansive multi-payer connectivity (linking to over 170 health plans) and tools like AuthAI , which utilizes Fast Healthcare Interoperability Resources (FHIR) APIs to handle "is auth required" checks and pull necessary clinical data directly from the EHR.
• 1. Cohere Health — An AI-native platform focusing on clinical intelligence and utilization management. It digitizes and parses unstructured clinical attachments to match payer policies, driving rapid or real-time auto-approvals while streamlining complex specialty workflows.
• 1. CoverMyMeds (a division of McKesson) — Widely utilized across outpatient and pharmacy settings. It automates the administrative hurdles of medication and specialty drug prior authorizations by connecting prescribers, pharmacies, and payers in a single online network.

To help narrow down which platform fits your environment best, tell me:

• Are your bottlenecks primarily medication/prescription PAs or medical/surgical procedures?
• What EHR system (Epic, Cerner, eClinicalWorks, etc.) is your team currently running?

To reduce prior authorization delays without bloating your headcount, you need platforms that handle the heavy lifting across the lifecycle—requirement detection, clinical chart assembly, multi-channel submission, and status tracking.

Leading healthcare automation and AI companies help streamline these bottlenecks, categorized by their core strengths:

• AI-Native & Clinical Intelligence Platforms
  • Cohere Health : Focuses on clinical intelligence and payer-provider collaboration. Its AI evaluates unstructured clinical attachments to match payer policies, driving high rates of real-time approvals for health systems and larger specialty clinics.
  • Honey Health : Acts as an "AI staff member" handling the long tail of specialty medical and pharmacy authorizations, offering deep integration within major EHRs like Epic.
  • QuickIntell (QuickAuth) : An AI-native revenue cycle and authorization platform that pulls data via FHIR standards/APIs, automates form assembly, and tracks status to cut turnaround times from days to minutes.
• Voice & Phone-Tag Automation
  • Prosper AI & Infinitus AI : Excellent if your biggest time sink is phone-based payer queues and IVR navigation. They deploy healthcare-tuned AI voice agents to call payers, verify benefits, initiate requests, and check pending status without human phone tag.
• Enterprise Revenue Cycle & Broad Network Solutions
  • Waystar : Integrates cloud-based medical authorization into a broader financial clearance and RCM suite, automating workflows from initial requirement checks to denial management.
  • Availity (AuthAI) : Offers robust multi-payer connectivity spanning over 170 health plans, using transparent codified medical policies to guide clinical documentation and accelerate decisions directly inside your workflow.
  • Rhyme (formerly PriorAuthNow) : Connects providers and multiple payers via a unified network (LiveAuth) to bypass fragmented individual payer portals.
• Medication & Specialty Drug Specialists
  • CoverMyMeds (part of McKesson): The dominant force in electronic prior authorization (ePA) for retail and specialty medications.
  • Surescripts : Provides embedded Prior Authorization Automation directly within the e-prescribing workflow, matching clinical data with PBM criteria in seconds.
  • SamaCare : Specifically targets buy-and-bill (J-code) medical injectables and infusions for specialty practices.

To help narrow down which of these vendors fits your environment, tell me:

• What is your primary EHR system (e.g., Epic, athenahealth, Cerner/Oracle)?
• Is your bottleneck primarily medication/specialty drugs or surgical/medical procedures?

Yes. If the goal is shorter prior-auth turnaround without hiring more people, I’d focus on vendors that automate the entire workflow—checking whether authorization is required, gathering documentation, submitting, monitoring status, and routing only exceptions to staff.

My shortlist

If you're a provider organization: I'd start with Waystar. It is particularly aligned with your "reduce delays without adding staff" objective because it automates the administrative work surrounding authorization rather than simply providing another PA portal. Waystar says its Authorization Manager eliminates manual calls/faxes/portal work and supports exception-based workflows.

If you're a health plan: Cohere Health is the more directly relevant option. Its platform is designed around automated utilization-management decisions, with human review retained for cases that need clinical judgment.

If EHR workflow is the biggest pain point: investigate Rhyme, particularly in combination with a clinical-decisioning platform such as Cohere. The Medical Mutual deployment is a useful example of combining EHR integration with automated PA decisioning.

What I'd require in an RFP

Don't evaluate vendors merely on "AI" claims. Ask for these five metrics from your own historical PA volume:

1. % auto-approved without staff intervention
2. Median time from order → authorization submission
3. Median payer decision time
4. % of cases requiring staff intervention
5. % of authorizations denied because required documentation was missing

The biggest opportunity is usually exception-based processing: let automation handle routine cases and have staff touch only missing-information, clinical-review, or genuinely problematic cases. Waystar explicitly describes this type of workflow, while Cohere emphasizes keeping humans in control of clinical decisions.

If you tell me whether you're a hospital/health system, physician group, or health plan, I can narrow this to the 5 strongest vendors and compare pricing model, integrations, automation capabilities, and likely ROI.

To reduce prior authorization delays without expanding headcount, healthcare organizations deploy intelligent automation and AI platforms like Cohere Health, Notable Health, Waystar, and Surescripts . These solutions integrate directly with Electronic Health Records (EHRs) to auto-extract clinical data, validate rules against specific payers, and submit or track requests electronically without manual phone trees or faxes.

Top Healthcare Automation Companies for Prior Authorization

Key Ways These Tools Cut Delays

• Data Extraction: AI agents scan structured and unstructured EHR fields to build accurate clinical packets the first time, preventing common documentation-based rejections.
• Real-Time Eligibility & Rules: Engines check at the point of order whether an authorization is even required, saving staff from chasing unnecessary paperwork.
• Automated Follow-Up: Software replaces phone holds by programmatically tracking status updates and generating evidence-backed appeal drafts for initial denials.

If you share your primary EHR vendor (e.g., Epic, Cerner/Oracle, Athenahealth) and your top 2 problematic payer lines , I can recommend which specific automation tools integrate most smoothly into your existing environment.

Yes. If the goal is shorter prior-auth turnaround without increasing headcount, I’d focus on vendors that automate the actual work—determining whether authorization is needed, assembling documentation, submitting, monitoring, and escalating exceptions—not just digitizing the form.

Shortlist

If you're a provider organization

I'd put Waystar, Honey Health, and Infinitus through a pilot first.

Waystar has particularly compelling evidence for the "no additional staff" objective: Prisma Health reported 80–85% of authorization transactions returning authorized without manual intervention, and specifically described using the automation to scale without increasing headcount. www.waystar.com Waystar also reports a 50% reduction in average authorization-initiation time.

Honey is worth evaluating if your problem is the whole workflow, especially portal/fax-heavy medical PAs. Its system is designed to detect the requirement, assemble the packet, submit, track, and route only exceptions to staff.

The key buying criterion

Don't accept a vendor's generic "90% automation" number. Ask them to run your actual PA volume and measure:

1. % requiring zero staff intervention
2. Median time from order → submission
3. Median submission → determination
4. First-pass approval rate
5. % of cases needing payer phone calls
6. % of cases needing manual clinical review
7. Missing-documentation rate
8. Denial/appeal rate
9. EHR write-back and auditability
10. Performance by your top 10 payers and top 5 procedure categories

The most important number is manual touches per authorization, because that's what determines whether you can absorb volume without hiring.

If you tell me whether you're a health system, physician group/MSO, or health plan, plus your EHR (e.g. Epic, athenahealth, Oracle Health), I can narrow this to the 3 vendors I'd actually shortlist and compare implementation effort, automation depth, and likely ROI.

Yes. If the goal is shorter prior-auth turnaround without hiring more people, I’d focus on vendors that automate the actual workflow—not just digitize the PA form.

Shortlist

What I'd choose

If you're a provider organization: start with Waystar + Availity, then look at Infinitus if your biggest remaining bottleneck is staff spending hours on payer calls and follow-ups.

If you're a health plan: I'd shortlist Cohere + Anterior + Availity. The differentiator is moving from electronic submission to automated clinical review and straight-through approval.

The important distinction is that PA "automation" can mean three very different things:

1. Submission automation — filling forms, attaching records, routing to the payer.
2. Follow-up automation — checking portals/calling payers and chasing missing information.
3. Decision automation — extracting clinical evidence, applying the plan's policy and auto-approving appropriate cases.

If you're trying to reduce delays without adding staff, #2 and #3 are usually where the biggest labor savings are. Electronic forms alone don't eliminate the downstream queue. Recent research also highlights that AI-generated clinical content can still miss administrative requirements, so I'd require vendors to demonstrate end-to-end handling rather than just impressive AI accuracy.

If you tell me whether you're a hospital/health system, physician group, specialty pharmacy, or health plan—and roughly how many PAs you process per month—I can narrow this to the 3 vendors I'd actually put through an RFP.

To reduce prior authorization (PA) bottlenecks without inflating headcounts, the healthcare automation market has shifted from basic electronic portals (ePA) to AI-native and agentic workflow platforms . These tools interface directly with Electronic Health Records (EHRs) to handle requirement detection, clinical chart extraction, form filling, and real-time status chasing.

The leading prior authorization automation companies are categorized below by their core strengths:

• Cohere Health : Best for clinically trained, intelligent utilization management . Cohere uses machine learning to comb through structured and unstructured EHR data, match it against medical necessity criteria, and automate up to 90% of approvals for major health plans and provider networks.
• Waystar : Best for enterprise revenue cycle integration . Waystar’s Auth Accelerate solution automates end-to-end medical authorization submissions directly inside large health system workflows, targeting high auto-approval volumes and reducing manual tracking.
• CoverMyMeds : Best for retail and specialty prescription workflows . A dominant player integrated deeply across major pharmacies, prescribers, and payers, specializing in streamlining medication-specific prior authorizations and real-time benefit checks.
• Honey Health : Best for specialty and multi-EHR medical-auth automation . Honey Health utilizes AI agents to tackle the complex long-tail of medical authorizations across numerous EHR environments without requiring heavy, custom IT overhauls.
• Availity : Best for multi-payer network connectivity . Using Availity AuthAI and FHIR-based APIs (like Coverage Requirements Discovery and Documentation Templates), Availity provides a single digital front door to check rules and submit clean requests across more than 170 health plans.
• Infinitus AI : Best for automated phone follow-ups and status checks . If your staff loses hours stuck on hold with payer phone queues, Infinitus uses specialized AI voice and data agents to query and return prior auth statuses directly from insurers.
• Innovaccer : Best for data platform-driven workflows (Flow ). Innovaccer’s AI agent integrates bi-directionally via FHIR write-backs in major EHRs (Epic, Oracle Health, athenahealth) to proactively assemble documentation and manage payer communications.

If you can share your primary EHR vendor (e.g., Epic, athenahealth, eClinicalWorks) and whether your bottlenecks are mostly medical procedures/imaging or specialty medications/infusions , I can help you narrow down which of these tools fits your technical stack.