IntelliHuman AVI Prior Auth
Prior authorization that thinks like your best clinician
Expert reasoning engine for prior authorization decisions, medical necessity determination, and appeal intelligence. Reduce denials. Accelerate approvals.
60%
Reduction in PA processing time
35%
Improvement in first-pass approvals
100%
Documentation compliance
50%
Faster appeal turnaround
The Prior Authorization Burden
Prior authorization is a necessary process that has become an unnecessary burden. Clinical staff spend more time on paperwork than patient care.
45%
of denials are eventually overturned on appeal—wasted time and effort
20+
hours per week staff spend on PA paperwork per provider
3-5
days average delay while waiting for authorization
$31B
annual industry cost of prior authorization burden
What AVI Prior Auth Does
Six core capabilities that transform prior authorization from burden to advantage.
Medical Necessity Reasoning
Analyze clinical documentation against payer criteria to build compelling medical necessity arguments. Cite specific clinical indicators.
Peer-to-Peer Prep
Generate talking points and clinical rationale for peer-to-peer reviews. Know what the medical director will ask before they ask it.
Appeal Intelligence
Analyze denial patterns and craft appeal strategies based on what has worked before. Turn denials into approvals.
Clinical Doc Matching
Automatically identify and extract relevant clinical documentation to support authorization requests.
Denial Pattern Analysis
Surface patterns in payer denials to improve first-pass approval rates and identify systemic issues.
Payer-Specific Rules
Apply payer-specific criteria and requirements automatically. Know what each payer needs before you submit.
How We Compare
AVI Prior Auth vs. common solutions in healthcare authorization
* General AI cannot access PHI safely and lacks clinical criteria databases
How AVI Prior Auth Works
From authorization request to approval—AVI Prior Auth reasons through medical necessity like your most experienced clinical staff.
Watch how AVI Prior Auth streamlines authorization decisions
Request Intake
Authorization request and clinical documentation flow into AVI Prior Auth. Patient history and procedure details are structured.
Criteria Matching
AVI Prior Auth matches clinical indicators against payer-specific medical necessity criteria.
Documentation Gap Analysis
Identifies missing documentation and suggests additional clinical evidence to strengthen the case.
Authorization Package
Generates complete authorization submission with medical necessity reasoning and supporting documentation.
Outcome Learning
Learns from approvals and denials to continuously improve first-pass success rates.
HIPAA-Compliant by Design
AVI Prior Auth is built with healthcare compliance at its core. PHI is protected, access is controlled, and every interaction is logged for audit purposes.
- End-to-end encryption
- Role-based access controls
- Full audit logging
- BAA available
Integrations
AVI Prior Auth connects with your existing EHR and payer systems.
Powered by the IntelliHuman Brain
AVI Prior Auth is built on expertise from utilization management nurses, medical directors, and clinical specialists. It reasons through medical necessity like they do—and learns from every decision.
Learn About the IntelliHuman BrainAdministrative Support, Not Clinical Advice
IntelliHuman AVI Prior Auth provides administrative decision support to assist with prior authorization processing and payer criteria matching. It does NOT:
- • Make autonomous clinical diagnoses or treatment decisions
- • Replace physician judgment or clinical decision-making
- • Provide medical advice to patients
- • Operate without licensed clinician review and approval
All authorization recommendations require review by licensed healthcare professionals who maintain final decision authority. AVI Prior Auth is designed to assist administrative workflows, not to replace clinical expertise. For more details, see our Healthcare AI Guardrails.
Healthcare Authorization Workflows
See how IntelliHuman automates prior authorization workflows with clinically-grounded AI
Prior Auth Decision Workflow
How AI evaluates medical necessity against payer-specific criteria to accelerate approvals
Medical Necessity Determination
How AI matches clinical indicators to payer medical policy requirements
Appeals Workflow
How AI analyzes denial reasons and generates appeal documentation with supporting evidence
Documentation Completeness
How AI evaluates clinical documentation against payer requirements before submission
Peer-to-Peer Prep
How AI prepares clinicians for P2P reviews with talking points and clinical rationale
Healthcare AI Guardrails
Learn how IntelliHuman ensures HIPAA compliance and clinical safety for healthcare AI
Key Concepts in Healthcare AI
Understand the core terminology behind intelligent prior authorization
Prior Authorization
Pre-approval process for medical services
Medical Necessity
Clinical appropriateness evaluation
Utilization Management
Healthcare resource optimization
Clinical Decision Support
AI-assisted clinical guidance
Policy-Native AI
AI that understands payer policies
Intelligent Reasoning Platform
Decision-making AI with explainability
Explainable AI
Transparent AI decision-making
Audit-Ready Automation
HIPAA-compliant audit trails
Ready to Transform Prior Authorization?
See how AVI Prior Auth can reduce processing time by 60% while improving approval rates.