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

If the goal is to reduce prior authorization delays without adding headcount, look for vendors that automate the repetitive work around intake, documentation gathering, payer submission, status checks, and follow-up—not tools that simply add another dashboard. The best fit depends on whether you are a provider, health system, payer, or specialty pharmacy.

Here are companies to evaluate:

How to narrow the list

If you are a physician group

Prioritize vendors that can:

• Pull clinical notes from the EHR
• Detect whether authorization is required
• Auto-fill payer forms
• Submit through existing payer channels
• Track pending requests automatically
• Surface missing documentation before submission

If you are a hospital or health system

Look for:

• Integration with your EHR, RCM, and utilization management systems
• Fax and portal automation
• Human-in-the-loop review for clinical decisions
• Audit trails and reporting
• Ability to handle exceptions rather than only “clean” cases

If you handle specialty drugs

Focus on:

• Benefits verification
• Enrollment/hub workflows
• Payer follow-up calls
• Medical vs pharmacy benefit complexity
• Patient-start acceleration

Questions to ask vendors before buying

1. What percentage of cases are fully automated vs. still require staff intervention?
2. Can you submit through payer portals/fax/EDI, or only via APIs?
3. How do you handle missing clinical documentation?
4. Do you integrate with our EHR and write status back?
5. How do you measure improvement—turnaround time, approval rate, staff hours saved, or fewer denials?
6. What happens when the AI is uncertain?

A practical shortlist for a provider organization trying to reduce delays without hiring would usually start with SamaCare, Ascertain, HiPaaS, UiPath, and Mandolin, then run a workflow pilot using your own authorization volume and payer mix.

To cut down prior authorization (PA) bottlenecks without inflating your headcount, you need platforms that handle everything from checking if an auth is required to auto-extracting clinical data, submitting via APIs/EDI, and tracking status.

Here are the top healthcare automation companies and platforms specializing in streamlining or fully automating the prior authorization lifecycle:

• Cohere Health — An AI-native platform focused heavily on clinical intelligence. It evaluates unstructured clinical notes and attachments to match payer policies, driving high rates of real-time approvals and integrating closely with EHR workflows. Learn more on the Cohere Health Website.
• Availity (AuthAI) — Offers extensive multi-payer connectivity. Availity uses FHIR-based APIs (like CRD, DTR, and PAS) to check if an authorization is required directly inside EHR workflows and automates the collection of necessary documentation and medical policies. Explore tools via the Availity Platform.
• Waystar (Authorizations Suite) — Uses a blend of intelligent automation and its Hubble robotic process automation (RPA) platform. It continuously adapts to shifting payer rules, manages submission tracking, and reduces manual touchpoints. Check details on Waystar.
• Rhyme (formerly PriorAuthNow) — Connects providers and payers directly to streamline the administrative burden, minimize fax/portal ping-pong, and accelerate turnaround times. Visit Rhyme.
• Experian Health (Authorizations) — Designed to guide staff and systems with minimal manual involvement, automating inquiries, checking eligibility, and actively monitoring authorization status through the pipeline. See features on Experian Health.
• Voluware (VALER platform) — Provides an end-to-end automation platform that unifies prior authorizations, referral management, and coverage determinations into a single structured workflow. Review the system at Voluware.

If you want to narrow these down, tell me:

• What EHR/EMR system are you currently running?
• Are your biggest delays happening during initial submission, gathering clinical notes , or chasing status updates?

To reduce prior authorization (PA) turnaround times without expanding your administrative headcount, you need platforms that handle the heavy lifting—such as pulling clinical data from your EHR, mapping it to specific payer rules, and handling the portal submissions or FHIR-based exchanges automatically.

The primary distinction when shopping for these tools is whether you are trying to solve pharmacy/medication PA or medical/surgical procedure PA , as the underlying networks differ significantly.

Leading healthcare automation companies addressing these workflows include:

• CoverMyMeds (by Surescripts) : The gold standard and most ubiquitous network for pharmacy ePA . It integrates directly into major EHR workflows to automate medication prior authorizations by connecting prescribers, pharmacists, and payers seamlessly.
• Waystar : A robust revenue cycle management (RCM) platform that embeds prior authorization and financial clearance automation directly into front-end workflows. It is well-suited for large provider groups managing heavy multi-payer volume.
• Rhyme (formerly PriorAuthNow) : Specializes in streamlining medical/surgical authorizations . It connects providers and payers collaboratively to eliminate fax/phone loops and reduce the administrative burden on clinical staff.
• Honey Health : An AI-native operations newcomer that acts as an intelligent assistant to flag requirements, pull documentation out of the EHR chart, and handle portal-and-fax navigation autonomously.
• Availity (AuthAI) : Leverages clinical intelligence and FHIR APIs (supporting CRD, DTR, and PAS protocols) to check if an auth is required, pre-compile clinical data, and process routine determinations rapidly within existing workflows.
• Forus : An AI-driven platform geared toward complex medication access, buy-and-bill support, specialty pharmacy coordination, and end-to-end PA tracking.

To help narrow down which of these systems fits your environment, could you share:

• Are your bottlenecks mostly medication (Rx) PA or surgical/medical procedure PA?
• What EHR/EMR system are you currently running?

If your goal is faster prior authorizations without hiring more people, I’d separate the market into payer-side clinical decisioning and provider-side workflow automation.

Strong vendors to evaluate

• coherehealth.com — Best fit if you're a health plan. Its platform automates utilization management and prior-auth decisions, including extracting clinical evidence and applying medical policies. Cohere says 85% of authorizations can receive real-time approval, depending on specialty.
• waystar.com — Strong option for hospitals/health systems and provider revenue-cycle teams, particularly if PA is part of a broader eligibility, claims and denial-management workflow.
• rhyme.healthcare — Worth considering when the major problem is connecting payer authorization workflows to the EHR. Rhyme has been used with Cohere to connect EMR workflows and automate authorization requests.
• covermymeds.com — Particularly relevant if a large share of your authorization burden is medications/pharmacy, rather than imaging, procedures or medical services.
• honeyhealth.ai — An emerging provider-side option focused on AI automation of the more difficult medical-authorization workflow, including chart information and the portal/fax "long tail."
• keragon.com — More of a workflow-automation layer than a clinical decision engine. It can automate tasks such as eligibility checks, assembling PA packets, status checking and follow-up—useful if staff are spending hours on administrative chasing rather than clinical review.

How I'd shortlist them

The important procurement question isn't simply "Who has AI?" It's what percentage of your current PA volume can actually become touchless. Vendor claims of 85–90% automation should be tested against your payer mix, specialties, documentation quality and the proportion of requests that legally/clinically require human review.

If you tell me whether you're a health system, physician group, specialty practice, or health plan, plus roughly how many PAs you process per month, I can narrow this to the 3 vendors I'd actually put into an RFP and give you a side-by-side evaluation framework.

Yes. If the goal is shorter prior-auth turnaround without increasing headcount, I’d focus on vendors that automate intake, clinical-document gathering, payer-rule checking, and routine approvals—not just software that gives staff another portal.

Strongest vendors to evaluate

• waystar.com — Best fit if your bottleneck is provider-side authorization and revenue-cycle operations. Its Authorization Manager automates eligibility/authorization requirements, payer-rule checking, submission, and status workflows. Waystar reports a 50%+ reduction in average authorization-initiation time and 70M authorization transactions annually.
• coherehealth.com — Particularly compelling for health plans and utilization-management teams. Its AI can automate routine medical-necessity decisions, extract clinical evidence, and integrate with EHR/UM systems. Cohere reports up to 85% real-time approval for eligible authorizations and offers in-house, delegated, and API-based deployment models.
• rhyme.health — Worth considering when the problem is EHR-integrated, touchless provider workflows. Rhyme's technology can connect authorization automation directly into EHR workflows; its partnership with Cohere and Medical Mutual was designed to automate the end-to-end process.
• availity.com — A strong option when multi-payer connectivity is the priority. It is more of an exchange/workflow layer than a pure AI clinical-decision engine, so I'd evaluate it alongside Waystar rather than treating them as identical products.

How I'd shortlist them

The key metric I'd demand in an RFP: not simply "automation rate," but % of authorizations requiring zero human touches, broken down by service line and payer. Also measure median time from order → submission → determination, first-pass approval rate, missing-document rate, and percentage requiring peer-to-peer review.

One important distinction: if you're a provider organization, I'd put Waystar/Rhyme higher; if you're a health plan, I'd put Cohere substantially higher. That changes the vendor landscape quite a bit.

If you tell me whether you're a health system, physician group, health plan, or specialty provider, I can give you a tighter 5-vendor shortlist with estimated implementation difficulty, strengths/weaknesses, and what I'd ask each vendor in a demo.

Several leading healthcare automation and artificial intelligence platforms specialize in streamlining prior authorizations (PAs) and eliminating touchpoints without expanding headcount . These solutions target data extraction, automated form submission, status checking, and clinical criteria matching directly within existing electronic health record (EHR) environments.

Top Healthcare Automation & AI Companies for Prior Authorization

How These Platforms Reduce Delays

• Data Extraction & Matching: Platforms like Notable Health utilize intelligent agents to pull required clinical data straight from unstructured EHR notes, mapping them instantly against complex payer medical necessity criteria.
• Automated Payer Follow-Up: Tools like Infinitus.ai use conversational AI to interact with payer interactive voice response (IVR) systems and representative lines, acquiring precise status updates without tying up human staff on hold.
• Real-Time Point-of-Care Decisions: Solutions like Surescripts bypass the traditional administrative queue entirely for standard qualifying prescriptions, securing touchless approvals before the patient even leaves the office or pharmacy.

If you'd like, let me know:

• Whether your bottleneck is primarily medications or surgical/procedural authorizations
• Your current EHR vendor (Epic, Cerner, Athenahealth, etc.)

I can help narrow down which platform integrates best with your specific infrastructure.

To reduce prior authorization (PA) delays without expanding your headcount, you need technologies that do more than just digitize forms—you need platforms that use AI and intelligent clinical extraction to automatically determine requirements, pre-populate paperwork, pull evidence from EHR charts, and handle stubborn payer follow-ups.

The leading healthcare automation companies addressing prior authorization bottlenecks include:

• Cohere Health – Known for its intelligent, clinical-intelligence platform (Cohere Health Provider Solutions ), Cohere uses AI to automatically extract clinical data from unstructured medical records, pre-populate submission criteria, and align with evidence-based care paths. A high percentage of requests through their network achieve real-time, instant approval without human intervention.
• Waystar – Waystar provides an end-to-end revenue cycle and financial clearance technology (Waystar Authorization Platform ) featuring Authorization Manager and AltitudeAI . It integrates deeply with major EHRs to instantly analyze orders, verify whether an authorization is required, and match clinical documentation to specific payer rules before submission.
• CoverMyMeds – A dominant player specifically for medication and pharmacy-side prior authorizations (CoverMyMeds ). They embed electronic prior authorization (ePA) directly into pharmacy and provider daily workflows, drastically reducing the phone-and-fax loop required by prescription benefit managers.
• Prosper AI – An emerging category of specialized AI agents that tackle the most agonizing part of PA—calling payers, navigating IVR phone trees, holding on the line, and speaking to insurance reps to check status or push through pends and denials without tying up your staff.

If you'd like to narrow this down, tell me:

• Are your current PA bottlenecks mostly for medications (pharmacy) or medical procedures/specialty services?
• What EHR system are you currently running?

I can help you evaluate which integration path makes the most sense for your team.

Yes. If the goal is shorter prior-authorization turnaround without hiring more people, I’d focus on vendors that automate different bottlenecks rather than simply adding another portal.

Strongest options to evaluate

How I'd choose

If you're a health plan: Start with Cohere Health. Its platform is specifically designed to automate routine authorization decisions and assist human reviewers with complex cases. Cohere reports up to 85% real-time approvals in some workflows and says its AI can extract relevant information from unstructured clinical attachments.

If you're a hospital/health-system RCM team: I'd put Waystar and CoverMyMeds at the top of the shortlist. Waystar says its Authorization Manager automates the authorization process and reports a 50% reduction in average authorization-initiation time.

CoverMyMeds is particularly interesting if your biggest problem is staff manually checking requirements, filling forms, submitting PAs and chasing status. It supports automated requirement checks, AI-assisted submission, real-time status and EHR documentation.

If the biggest bottleneck is phone-based follow-up: Infinitus is worth testing alongside whichever core PA platform you use. Its voice AI makes payer calls and returns authorization status/requirements through an API or its portal.

My practical shortlist

I'd run a vendor evaluation around these four:

1. Cohere — strongest candidate for automating the clinical decision/review side.
2. Waystar — strongest broad hospital authorization workflow candidate.
3. CoverMyMeds — particularly strong for in-workflow/ePA and pharmacy-related authorization.
4. Infinitus — compelling for automating payer calls and follow-ups.

The key question isn't just "Which vendor has AI?" It's "Where are our PAs spending the most human minutes?" If you tell me whether you're a health system, physician group, health plan, specialty pharmacy, or other organization, and roughly how many PAs you process per month, I can narrow this to the 2–3 vendors I'd actually put through an RFP, including estimated ROI and implementation considerations.

How I'd choose

If you're a health plan: Start with Cohere Health. Its platform is specifically designed to automate routine authorization decisions and assist human reviewers with complex cases. Cohere reports up to 85% real-time approvals in some workflows and says its AI can extract relevant information from unstructured clinical attachments.

If you're a hospital/health-system RCM team: I'd put Waystar and CoverMyMeds at the top of the shortlist. Waystar says its Authorization Manager automates the authorization process and reports a 50% reduction in average authorization-initiation time.

CoverMyMeds is particularly interesting if your biggest problem is staff manually checking requirements, filling forms, submitting PAs and chasing status. It supports automated requirement checks, AI-assisted submission, real-time status and EHR documentation.

If the goal is shorter prior-auth turnaround without hiring more people, I’d focus on vendors that automate the work around the authorization—not just electronic submission.

Strong vendors to evaluate

• waystar.com — Probably the broadest fit for a provider/health-system RCM operation. Its Authorization Manager automates determining whether authorization is required, initiating/submitting requests, checking status, and routing exceptions to staff. Waystar reports a 50%+ reduction in average authorization-initiation time and supports 70M authorization transactions annually. Waystar Waystar Best for: health systems wanting to automate the end-to-end workflow and reduce manual payer-portal work.
• infinitus.ai — Particularly interesting if your bottleneck is phone calls and follow-up. Its voice AI agents call payers, retrieve PA status/requirements, handle approval/denial information, and return the results to your system. It says it can make unlimited calls without expanding the team. Infinitus Infinitus Best for: specialty pharmacy, oncology, infusion, DME, diagnostics, or any operation where staff spend hours on payer calls.
• coherehealth.com — More oriented toward clinical utilization management and intelligent decisioning, especially on the health-plan side. Cohere says its platform can approve up to 85% of authorizations in real time, extract clinical evidence from unstructured records, and automate policy-driven decisions. Cohere Health Cohere Health Best for: payers/health plans or organizations that want to automate medical-necessity review rather than merely automate paperwork.

How I'd shortlist them

One important distinction: if you're a provider organization, I'd put Waystar and Infinitus at the top of the evaluation. Cohere is particularly compelling if you're a health plan or have substantial control over the utilization-management decision process.

For an apples-to-apples vendor evaluation, I'd ask each company to demonstrate a real authorization from EHR order → payer requirements → submission → missing-document chase → status check → approval/denial → staff exception, and measure touches per PA, median turnaround time, % requiring human intervention, and denial/rework rate. That will tell you much more than an advertised automation percentage.

Reducing prior authorization (PA) bottlenecks without expanding headcount requires shifting away from manual form-filling and phone/fax follow-ups toward clinical-grade AI, Robotic Process Automation (RPA), and direct EHR-integrated platforms . These technologies extract unstructured clinical data, pre-populate payer requirements, and secure real-time or touchless approvals.

Top Prior Authorization Automation Vendors

• • Core Technologies: Clinical-grade precision AI and Large Language Model (LLM)-driven data extraction. It uses "administrative nudges" to guide staff on missing documentation prior to submission.
  • Integration Capabilities: Deep EHR integration and web-based intake supporting medical services, procedures, and specialty care.
  • Impact & ROI: Delivers up to 85% real-time approval rates and cuts clinical review times significantly, reducing the back-and-forth friction of manual processing.
• Rhyme (Formerly PriorAuthNow)
  • Core Technologies: Touchless, workflow-embedded automation engine designed to track and eliminate administrative waste across the end-to-end lifecycle. Features dedicated "Gold Carding" modules to bypass auths entirely for trusted providers.
  • Integration Capabilities: Deep EHR integration; partners with over 50 large health systems and 300+ health plans.
  • Impact & ROI: Processes millions of authorization cases annually, removing manual status checks and slashing phone/fax volume.
• • Core Technologies: Enterprise revenue cycle automation, intelligent eligibility verification, and automated authorization tracking.
  • Integration Capabilities: Broad compatibility with major electronic health record (EHR) and practice management systems (PMS).
  • Impact & ROI: Centralizes tracking dashboards so existing staff can manage exceptions rather than routine submissions, scaling output without extra full-time equivalents (FTEs).
• CoverMyMeds
  • Core Technologies: Electronic prior authorization (ePA) platform specialized heavily in specialty medications and pharmacy-driven workflows.
  • Integration Capabilities: Extensive direct connectivity spanning major retail/specialty pharmacies, payers, and dominant health systems like Epic.
  • Impact & ROI: Dramatically accelerates medication turnaround times and reduces prescription abandonment due to delayed approvals.
• • Core Technologies: Autonomous AI agents specialized in handling the complex "long tail" of medical authorizations for specialty practices and MSOs.
  • Integration Capabilities: Built with native Epic and specialty EHR connectivity.
  • Impact & ROI: Automates unstructured clinical data extraction and submission tracking to minimize manual staff data entry.

Comparison of Top Vendors

If you share your primary EHR system (e.g., Epic, Cerner/Oracle, Athenahealth) and whether your volume is mostly medication-based or medical/surgical procedures , I can help narrow down which vendor offers the tightest integration for your workflow.