PriorAuth Pilot

PriorAuth Pilot is an automated prior-authorization packet readiness intelligence engine engineered for US outpatient clinics, specialty medical practices, and healthcare revenue cycle management (RCM) teams. In under 60 seconds, it ingests referral notes, clinical summary documents, diagnostic imaging reports, payer authorization forms, and insurance cards to detect missing clinical evidence, pinpoint payer-specific guideline gaps, flag CPT and ICD-10 coding inconsistencies, and assemble submission-ready authorization packets.

### The Problem
Outpatient clinics complete an average of 39 prior authorizations per physician each week, consuming more than 13 administrative staff hours. Prior-authorization rejections and delays stall patient care, defer critical medical procedures, create severe revenue leakage, and trigger costly denial appeals. Clinic teams juggle conflicting payer checklists across hundreds of commercial and Medicare plans with inconsistent manual reviews and no structured audit trail.

### The Solution
PriorAuth Pilot fuses Sensifai AI Engine multimodal clinical document understanding with deterministic payer requirement cross-checks. It extracts clinical criteria from unstructured physician notes and diagnostic reports, cross-references payer-specific medical necessity guidelines, verifies CPT and ICD-10 diagnostic consistency, and scores submission packet readiness from 0 to 100. Clean packets proceed straight to submission, while flagged gaps display exact clinical evidence references and actionable correction instructions.

### Key Capabilities
- Multimodal clinical document extraction covering physician notes, EMR summaries, diagnostic lab reports, and payer forms
- Payer-pattern requirement checklists tailored for major commercial payers and Medicare Advantage plans
- Deterministic CPT and ICD-10 medical necessity consistency validation
- Clinical evidence gap spotting with exact document page references and confidence scores
- Denial risk scoring and automated appeal packet generation from denial letter snapshots
- Instant Sensifai prepaid wallet metering at €0.05 per prior-authorization packet audit

### How It Works
Sign in with your Sensifai account, select a realistic clinical audit preset or upload clinic documentation, and inspect real-time packet readiness telemetry and generated appeal packets metered transparently at €0.05 per action from your Sensifai prepaid wallet.