Prior Authorization Agent
Move prior authorizations forward without the portal chase
Rinova follows configured payer-portal workflows to check requirements, assemble available information, prepare and submit routine requests, monitor status, and return exceptions to the appropriate staff member.
From scheduled service to visible authorization status
Synthetic records only. No patient information.
Human review branch: see “Missing documentation” and “Payer requests more information”, where the agent stops and a person takes over.
A configured service with complete documentation moves through the portal workflow.
Current step
CompletedMonitoring status
Status is rechecked at the configured interval and updates are written to the work queue.
- Next action
- Recheck status in 24 hours
The agent completes administrative portal work only. It does not create clinical facts, sign on behalf of a clinician, or make medical-necessity decisions.
Step 6 of 6. Monitoring status. Completed.
What to expect
About 1 minute
For routine portal actions
Status checks performed on schedule
Confirmation numbers and responses captured automatically
Human review preserved for clinical and unusual cases
Results vary by organization, specialty, payer mix, claim volume, system access, workflow scope, and starting performance.
What the agent can handle
- Checks whether a configured service requires authorization when payer information is available
- Reads approved chart, order, diagnosis, and insurance fields
- Completes routine payer-portal forms
- Attaches available supporting documents
- Captures submission references and timestamps
- Monitors pending requests at configured intervals
- Writes status and next actions into the approved queue or system location
- Routes missing documentation, clinical questions, peer-to-peer requests, and other exceptions to staff
Clinical judgment stays with clinicians
The agent automates administrative portal work within configured rules. It does not invent clinical documentation or make care decisions. Requests that need a clinician's statement, medical-necessity interpretation, signature, or peer discussion are escalated with the relevant context.
Configured around payer and practice rules
Rinova maps the services, payers, portals, documentation sources, due dates, and approval points used by the organization. The agent is tested against representative cases before live submission is enabled.
Prior Authorization questions
Coverage depends on the payer, portal, service, documentation requirements, and the actions the organization approves. Rinova defines supported workflows during discovery and routes unsupported cases to staff.
The agent can retrieve approved clinical information already present in the record. It does not create clinical facts or replace a clinician's judgment, attestation, signature, or peer discussion.
The agent checks status according to configured intervals, records payer responses, and updates the designated work queue or system location.
Related AI Agents
- Eligibility Verification AgentChecks upcoming appointments, retrieves coverage and benefit details, writes results to the approved destination, and routes exceptions to staff.View agent
- Claim Status and Follow Up AgentChecks clearinghouse and payer status through APIs and approved portals, updates the accounts receivable queue, and sets the next action.View agent
Show us the portals consuming your team's day
We will map a representative authorization workflow and demonstrate where routine steps can be automated safely.