01
Check requirements earlier
Organize payer, plan, service, and documentation requirements before staff spend time building the request.
PRIVATE PRODUCT CONCEPT
Give every prior authorization a clearer path.
PriorAuth Navigator helps healthcare teams understand requirements, gather supporting records, prepare review packets, coordinate follow-up, and see where requests are delayed. Authorized clinical and administrative staff stay responsible for every decision.
Administrative decision support only. PriorAuth Navigator does not make medical-necessity, coverage, authorization, or payment decisions.
THE OPERATIONAL BENEFIT
Know what is needed before the request moves forward.
PriorAuth Navigator brings the service request, reviewed requirements, supporting records, missing items, ownership, and follow-up status into one controlled work queue.
Staff can see what is required, what evidence is available, what is missing, who is responsible, and when the next action is due. Leaders gain a structured view of the delays that affect scheduling and care coordination.
02
Prepare a complete packet
Bring the order, supporting records, checklist, and missing items into one workspace for authorized review.
03
Keep follow-up visible
Track ownership, submission status, requests for more information, due dates, and the next approved action.
04
Find avoidable delays
See where missing documents, unclear ownership, or repeated requirements slow the authorization process.
THE AUTHORIZATION WORKBENCH
Prepare the request, then let the right people review.
A useful authorization workspace connects reviewed requirements to the service request, evidence, due date, clinical review, and approved action.
01 / INTAKESynthetic authorization request
02 / REQUEST PLANPrepared for authorized review
PROPOSED NEXT STEPComplete and review
REVIEW REQUIRED- Requirement
- Reviewed plan and service criteria
- Evidence
- Available records and supporting source passages
- Open item
- Missing, unclear, or conflicting information
- Timing
- Internal target and payer follow-up date
Illustrative interface using synthetic information. No patient data, clinical decision, or submitted authorization is shown.
REQUEST TO FOLLOW-UP
A controlled six-step workflow.
Exact steps depend on the organization, care setting, payer, plan, requested service, urgency, and systems of record.
- 01
Receive
Capture the approved service request and the operational details needed to begin.
- 02
Check
Match the request to reviewed plan, payer, and service requirements.
- 03
Gather
Locate supporting records and show what is available or still missing.
- 04
Prepare
Assemble a review packet with evidence, questions, and the proposed next action.
- 05
Review
Let authorized clinical and administrative staff correct, approve, or escalate the packet.
- 06
Track
Record submission status, follow-up, deadlines, and the final operational outcome.
A BOUNDED FIRST PILOT
Start with one service line and its authorization work.
Start with one service line, representative edge cases, qualified reviewers, and acceptance criteria the organization understands.
FIRST PILOT
What the evaluation can include
- One defined service line or authorization workflow
- Synthetic or properly de-identified evaluation records
- Reviewed requirement and routing rules
- Evidence and missing-document checklist
- Authorized clinical and administrative decisions
- Agreed baseline and acceptance measures
PRODUCTION BOUNDARIES
What requires separate approval
- Approved access to orders and supporting records
- Current payer, plan, and authorization requirements
- Secure hosting and applicable business associate agreements
- EHR, practice-system, or payer integration
- Role-based access and audit retention
- Controlled submission only after written approval
MEASURE BEFORE EXPANDING
Measure whether requests become review-ready sooner.
Compare preparation time, missing items, assignment speed, reviewer agreement, follow-up touches, and avoidable delays.
01Minutes spent preparing each authorization request
02Requests assigned within the internal target
03Missing items found before submission
04Reviewer agreement and correction rate
05Days from request receipt to approved submission
06Follow-up touches and avoidable delays
RESPONSIBLE OPERATION
The system prepares. Authorized staff decide.
Keep reviewed requirements and effective dates connected to the prepared work.
Route medical-necessity questions and clinical evidence to qualified staff.
Give each person only the records and actions needed for the approved purpose.
Send incomplete, conflicting, urgent, or unsupported cases to qualified review.
BUILD WITH AI GAUR
Choose one authorization workflow worth improving.
We can map the present process, identify the requirements and controls, and define a pilot your healthcare operations team can evaluate.
Discuss a PriorAuth Navigator pilot Do not submit patient records or protected health information through the public contact form.Questions worth asking.
What does PriorAuth Navigator provide to an authorization team?
PriorAuth Navigator organizes the order, reviewed requirements, supporting records, missing items, deadlines, ownership, follow-up, and final disposition in one controlled workflow. Staff can see what is ready for review and what still needs attention.
Can it help find missing information before submission?
Yes. The system can compare configured requirements with available information, surface missing or conflicting items, and prepare questions for authorized clinical or administrative review before the request moves forward.
What can a PriorAuth Navigator pilot evaluate?
A pilot can focus on one service line, request type, or payer workflow. It can measure preparation time, missing items found before submission, assignment speed, reviewer agreement, follow-up touches, and avoidable delays.
Can PriorAuth Navigator connect to an EHR, practice system, or payer portal?
Yes, when the system provides suitable access and the organization approves the architecture, permissions, security controls, and business agreements. Integrations are scoped separately and begin read-only wherever practical.
How does PriorAuth Navigator fit with ClaimReady and DenialDesk?
PriorAuth Navigator supports authorization work before a planned service. ClaimReady supports documentation and coding review before a claim moves forward. DenialDesk organizes work after an adverse payer response. Each system addresses a different operational stage.
Does PriorAuth Navigator make medical-necessity decisions or submit without review?
No. It prepares and organizes the work. Qualified clinicians and authorized staff remain responsible for medical-necessity judgment, documentation, final review, and any submission.
Can PriorAuth Navigator guarantee approval?
No. Coverage, benefit terms, medical-necessity criteria, documentation, eligibility, plan rules, and payer decisions can affect the result. The product supports the workflow and does not guarantee authorization, coverage, payment, or clinical appropriateness.