Solution · Prior Authorization
Prior authorization automation that works every auth to approval.
Simz automates the auth workflow end to end, determining what needs authorization by payer, plan, and CPT, assembling the request from the record, tracking status to approval, and watching every expiration, with your staff approving every submission.
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The cost of this bottleneck
The most expensive fax you'll never see is the one a payer didn't get
Auth requirements change by payer, plan, and procedure. Staff chase portals, fax lines, and phone trees to find out what's needed, then chase them again for status, resulting in failures that surface as unpaid services and delayed patients:
…while patients wait, schedules slip, and staff redo the same lookups daily.
Whether auth is required depends on payer, plan, and CPT, and the matrix changes constantly.
Each payer has its own portal, forms, and fax number; staff log in daily just to check status.
Auth windows close while cases wait to be scheduled, discovered only when the claim denies.
Missing clinicals and wrong codes trigger avoidable pends and delays.
Every day an auth sits unworked is a day of delayed care and schedule churn.
BEFORE / AFTER
How it works today vs. with Simz
Staff memory, sticky notes, and payer phone calls
Hunting the chart for clinicals, demographics, and codes
Daily portal logins and hold music
A date on a sticky note, if anyone wrote it down
None until the denial arrives
HOW IT WORKS
The automation, step by step
Determination on arrival
The moment an order or case lands, the rules engine determines whether authorization is required by payer, plan, and procedure code.
Packet assembly
Demographics, clinicals, and codes pulled from the extracted record into a complete, submission-ready request, flagged to your staff for approval.
Tracked to approval
Once submitted through your channels, status is followed automatically on a cadence, with pends and requests for information surfaced immediately.
Expiration watch
Approved auth numbers and windows are extracted and monitored; approaching lapses trigger alerts and scheduling action before the window closes.
Denial feedback loop
Auth-related denials feed back into the rules engine and the Denials & Appeals workflow, so the same failure doesn't happen twice.
Payer/plan/CPT rules engine
A maintained table of authorization requirements, updated as payers change, applied identically to every case.
Auto-assembled auth packets
Complete requests built from the extracted order and record, ready for staff review.
Status tracking & follow-up
Automated cadence on every open auth, with alerts only on pushback, not daily portal duty.
Expiration countdown alerts
Every window watched; scheduling and re-auth triggered before a lapse, not after a denial.
Re-auth on change
Plan, dose, and cycle changes automatically re-checked against auth requirements.
Auth analytics
Turnaround by payer, pend reasons, expiration saves, and denial correlation, live.
Your staff stays in control: Simz determines, assembles, tracks, and watches, while your team reviews and approves every submission through your existing payer channels. Automation does the chasing; people make the calls.
Where it bites hardest
See this automation in your specialty
Why we're confident
This engine is already running in production
The platform behind this solution is live today with a multi-site radiology group in Southern California, a phased engagement covering AI intake, real-time eligibility, authorization tracking, a 24/7 phone agent, and analytics, on one MSA, one BAA, one HIPAA framework.
Powered by Simz Conversational, Simz Shift, and Simz Chron, with custom development for everything else.
- BAA executed before any PHI moves
- HIPAA-eligible infrastructure end to end
- Human review on every uncertain AI decision
- Role-based access with full audit logging
- Accuracy benchmarked on your documents, and locked as acceptance criteria
FAQ
Prior Authorization, answered
Kill this bottleneck first.
Thirty minutes with your operations lead. We map how prior authorization works in your practice today, quantify what it's costing you, and hand you an automation roadmap. Whether or not you build it with us.