Clinic staff spend half their time on insurance prior authorizations, facing arbitrary denials like for a rehab bed for a patient who is unsafe to transfer and lives alone, despite insurers posting massive profits.

Workarounds Described

• Manually filling prior auth forms and tracking statuses
• Drafting appeals by hand for each denial
• Calling insurance companies to follow up

Implied Software Gaps

• Automated prior authorization submission and tracking system
• AI-assisted appeal generation with evidence-based argument templates
• Integration with payer APIs for real-time status updates and pattern analysis

PriorAuthGuard

An AI-powered platform that automates prior authorization submissions and appeals, using data-driven insights to predict and prevent denials. It integrates with payer systems to streamline the process and flags inappropriate denials for regulatory review, ensuring patients get the care they need faster.