Since Prior Authorization is a critical cost control mechanism for Health Plans, their team of clinical reviewers need to thoroughly review documents containing members clinical history to evaluate the medical necessity of the procedure or medication prescribed as per federal, state or health plan determination guidelines. The requests are manually reviewed making the process time consuming, inefficient and adding more administrative cost & burden.

CitiusTech's Gen AI Payer Prior Auth solution can help shorten the TAT required to review and approve requests by generating a summarized and relevant synopsis of the members clinical history.

Payer Value Proposition

Reduced Administrative overhead: Extract and summarize relevant clinical information from the case attachments, in accordance to applicable coverage determinators or health plan coverage guidelines. This can help reduce the manual effort required to review documentation to evaluate medical neccessity.

Faster information retrieval: Clinical reviewers can get additional answers to specific questions about members through a simple chat-based interface thereby reducing the amount of time needed to process.

Member Value Proposition

Reduced TAT: Reduced time required for processing prior auth requests can help improve member experience and build a stronger NPS