elsai

Prior authorization is the single most administratively burdensome process in US healthcare. The American Medical Association’s 2024 Prior Authorization Survey found that 94% of physicians report preauth delays that negatively affect patient care, and the average practice completes 45 prior authorizations per physician per week — consuming nearly two full business days of physician and staff time.

The CMS Prior Authorization Final Rule (CMS-0057-F) mandates electronic prior authorization for Medicare Advantage, Medicaid, and CHIP plans, with impacted payers required to implement HL7 FHIR-based preauth APIs. Health systems that have not automated prior authorization are facing both a compliance deadline and an operational cost problem simultaneously.

Prior authorization AI agents reduce preauth cycle times from days to hours. They automate clinical data extraction, validate payer rules, submit requests, and track authorization status in real time instead of relying on manual phone calls, faxes, and portal checks.

The Top 6 Prior Authorization AI Agent Providers in 2026

elsai — Governed agentic prior authorization automation

elsai is the governed agentic operations platform for healthcare, with elsai Prior Authorization automation as its flagship workflow. elsai deploys coordinated AI agents across the full preauth lifecycle intake, data validation, payer rules matching, submission, status tracking, and denial management with a mandatory Human-in-the-Loop (HITL) gate at every material decision point. The Agent Resource Management System (ARMS) logs every agent action, data source, confidence level, and human approval in a tamper-evident audit trail stored in your own infrastructure.

Key capabilities:

• Multi-source clinical intake from Epic, Cerner, Athena, and Meditech — no manual re-keying of patient or clinical data

• HITL checkpoint at every decision gate — AI recommends, a named clinician or preauth coordinator approves before any submission

• ARMS audit logs: every action timestamped, data-sourced, confidence-scored, and stored in your infrastructure

• On-premises and air-gapped deployment — the only platform in this comparison with a fully air-gapped option

• 40–60% reduction in preauth workflow turnaround time; 15–30% reduction in denial rates (Source: McKinsey, AMA, HFMA, AHRQ 2024–2025)

Best for: Health systems, hospitals, and provider groups that require governed agentic preauth automation with full HITL accountability, on-site audit logs, and optional on-premises or air-gapped deployment for PHI data residency requirements.

Key consideration: elsai is a workflow automation and governance platform, not a standalone patient-facing preauth portal. Health systems seeking consumer-facing preauth request initiation for patients will need to integrate a separate patient-portal layer.

Cohere Health — AI-powered prior authorization for health plans and their provider networks

Cohere Health is a clinical AI platform that automates prior authorization decisions across a two-sided network connecting health plans and the provider organisations they serve. Health plans contract with Cohere to process incoming preauth requests using clinical AI aligned to evidence-based pathways; providers covered by a Cohere-enabled plan gain access to streamlined, often real-time preauth decisions including partnerships with Humana and Blue Cross Blue Shield plans covering tens of millions of members.

Key capabilities:

• Clinical AI that processes preauth requests against evidence-based pathways reducing medically unnecessary denials

• Real-time preauth approvals for clinically straightforward cases bypassing manual review queue entirely

• Smart pathways that guide providers to the right clinical information at submission, improving first-pass approval rates

Best for: Health plans and managed care organisations seeking to automate preauth processing and reduce inappropriate denials and providers whose primary payer partners have adopted Cohere’s clinical network.

Key consideration: Value depends on payer mix providers outside Cohere-enabled plans need a separate provider-side solution.

Waystar (Myndshft) — Prior authorization automation within a full revenue cycle platform

Waystar acquired Myndshft in 2022, integrating Myndshft’s prior authorization automation capabilities into Waystar’s revenue cycle management (RCM) platform. The combined offering covers the full revenue cycle eligibility verification, preauth requirement detection, preauth submission and status tracking, claim submission, and denial management within a single vendor relationship. Myndshft’s real-time database of preauth requirements by CPT/HCPCS code, payer, and plan continues within Waystar, eliminating the manual burden of tracking payer policy changes.

Key capabilities:

• Real-time preauth requirement detection: identifies which procedures need preauth by CPT/HCPCS code, payer, and plan with continuous payer rules updates

• Full RCM integration: preauth, eligibility, claims, and denial management in a single platform

• Denial pattern analytics identifying systematic documentation gaps across submission history

Best for: RCM teams, health systems, and healthcare organisations that want preauth automation as part of a unified revenue cycle platform particularly those already using Waystar for claim submission or denial management.

Key consideration: Evaluating Myndshft means buying into the full Waystar ecosystem confirm this aligns with your existing vendor stack.

Rhyme — Provider preauth network and real-time payer connectivity

Rhyme (formerly PriorAuthNow) connects providers and payers through a real-time preauth network, building direct payer integrations that enable faster preauth decisions than portal-based submission. The platform is particularly strong for specialty practices and MSOs managing high preauth volume across a broad payer mix.

Key capabilities:

• Real-time preauth network: direct payer integrations enabling faster decisions than portal-based submission

• AI-assisted payer requirement detection and clinical documentation prompting at submission

• Specialty-specific preauth workflows for high-volume specialties: oncology, radiology, cardiology, musculoskeletal

Best for: Provider groups, specialty practices, physician management companies, and MSOs with high preauth volume and a broad payer mix particularly where portal fragmentation and submission overhead are the primary operational bottleneck.

Key consideration: Governance documentation and on-site audit trails are limited evaluate carefully if compliance documentation is a hard requirement.

Navina (now part of Abridge) — Clinical AI documentation and patient record synthesis

Navina was a clinical AI platform specialising in patient record synthesis aggregating longitudinal EHR data to surface clinically relevant information for HCC risk coding and preauth documentation. In late 2024, Navina was acquired by Abridge, the ambient AI documentation company partnering with UPMC and other major health systems. Within Abridge, Navina’s record synthesis capabilities are being integrated to enrich ambient documentation with longitudinal clinical context.

Key capabilities:

• Patient record synthesis: aggregates EHR data across visits, diagnoses, medications, and labs into a structured clinical summary

• HCC risk coding support: surfaces unaddressed conditions and risk-relevant diagnoses relevant to preauth documentation

Best for: Ambulatory care groups, primary care organisations, and physician practices where the preauth bottleneck is the physician’s time assembling clinical evidence and where ambient documentation is also a priority, making the combined Abridge/Navina platform relevant.

Key consideration: Navina is transitioning into Abridge’s platform confirm current product packaging and standalone availability before shortlisting.

Infinitus Systems — AI phone agent for prior authorization follow-up and payer calls

Infinitus Systems builds AI voice agents — branded ‘Eva’ that make and receive phone calls to payers on behalf of providers to check preauth status, verify eligibility, and initiate preauth requests via IVR. Provider organisations make an estimated 75 million preauth-related calls annually; Infinitus automates this call volume entirely, with Eva navigating IVR menus and extracting structured preauth status data without human hold time.

Key capabilities:

• AI phone agent (Eva) that autonomously makes and receives payer calls no humans on hold

• preauth status checking via payer IVR: retrieves real-time approval status without portal access

• Call log transparency: every call recorded with timestamp, payer response, and structured output

Best for: High-volume preauth teams, specialty pharmacy operators, and provider organisations where a significant portion of preauth time is consumed by outbound payer calls, hold queues, and IVR navigation rather than documentation assembly or portal submission.

Key consideration: Phone-channel only best positioned as a complement to a full preauth automation platform, not a standalone solution.

The Right Platform Is the One That Fits the Problem You Actually Have

Most prior authorization teams evaluating AI vendors are not short on options they are short on clarity about which part of the workflow they are actually trying to fix. A phone automation tool, a payer connectivity network, a clinical documentation assistant, and a governed end-to-end agentic platform are solving genuinely different problems. Picking the wrong one leaves the actual bottleneck untouched.

For health systems where compliance teams have raised questions about data handling and decision accountability, speed is table stakes. What matters is whether every AI decision can be explained, attributed, and inspected on demand and that is the problem elsai is specifically built to solve.

FAQ

What is a prior authorization AI agent?

A preauth AI agent is an AI-driven system that automates the clinical and administrative steps of the prior authorization workflow clinical data extraction from EHR records, payer requirement detection, preauth submission, status tracking, and denial management. ‘Agentic’ AI means the system takes multi-step actions autonomously, with a human review gate at key decision points, rather than only generating a recommendation for a human to act on manually.

How much time does prior authorization automation save?

Preauth automation reduces workflow turnaround time by 40–60% and administrative staff time by 30–50%. The AMA estimates physicians and staff spend nearly two full business days per week on prior authorizations. Agentic platforms that handle intake, validation, submission, and tracking recover the majority of that time. (Source: McKinsey, AMA, HFMA, AHRQ 2024–2025)

What is the difference between prior authorization software and an agentic AI platform?

Traditional preauth software automates discrete tasks form auto-population, portal submission, status tracking but still requires significant human coordination between steps. An agentic preauth AI platform deploys agents that work across the full workflow end-to-end, without manual handoffs. The key distinction: human coordination only at governed decision gates, not at every step.

Which prior authorization AI platform is best for on-premises deployment?

elsai is the only platform in this comparison supporting fully on-premises and air-gapped deployment. The agent orchestration engine, ARMS audit logs, clinical data processing, and HITL workflows all run inside your own infrastructure no data leaves the environment. For health systems with PHI data residency requirements or policies prohibiting clinical data transmission to cloud AI endpoints, elsai’s on-premises option is the only compliant choice in this list.

Can prior authorization AI help reduce denial rates?

Yes. Preauth AI platforms that validate clinical criteria before submission — checking documentation matches the payer’s coverage policy for the specific CPT code, plan, and patient — reduce first-pass denial rates by 15–30% compared to manual submission. (Source: McKinsey, HFMA 2024–2025)

Discover how governed AI can modernize prior authorization operations across healthcare organizations.