Generate a new prior authorization letter from patient clinical data
Fight a denied PA with an evidence-backed rebuttal letter
AI that fights back against prior auth denials
PriorAI is an autonomous prior authorization agent built on FHIR R4, Da Vinci PAS, and the A2A protocol. It eliminates the #1 administrative burden in US healthcare — prior authorization. Physicians waste 13 hours/week on PA paperwork, and insurers use automated AI systems to deny claims faster. PriorAI puts clinical-grade, standards-compliant capabilities back into the physician's hands.
The administrative burden of manual prior authorization delays patient care and burns out clinical staff:
PriorAI is equipped with an advanced autonomous reasoning pipeline that performs 13 essential clinical functions:
Test different edge cases using our high-fidelity, synthetically simulated patient profiles:
PriorAI is built on the HL7 FHIR R4 (Fast Healthcare Interoperability Resources) standard — the CMS-mandated interoperability format. This ensures our agent can ingest clinical data from any modern Electronic Health Record (EHR) system.
We use FHIR resources including Patient, Condition, MedicationRequest, MedicationStatement, Observation, Encounter, and Practitioner to build the complete clinical context required for a Prior Authorization — eliminating manual data entry.
The Da Vinci Prior Authorization Support (PAS) implementation guide is at the core of our submission engine. It enables fully electronic exchange of PA requests between providers and payers, replacing manual faxing and phone calls.
Our agent generates compliant Claim, DocumentReference, and Provenance resources that follow the PAS profiles, ensuring high interoperability with payer systems and reducing administrative overhead by up to 90%.
PriorAI fully implements the 2026 CMS-0057-F rule by automatically scanning intake notes for qualifying clinical emergencies. If life, health, or recovery is threatened, the agent flags the request for 72-hour expedited review under Federal law, forcing insurers to comply with the mandated 72h decision window.
PriorAI implements the A2A Protocol v1.0 for autonomous agent communication. This enables our agent to be discovered and utilized by any A2A-compliant healthcare platform, including the Prompt Opinion Marketplace.
By following the Agent Discovery (/.well-known/agent.json) and Task Execution specs, PriorAI supports both JSON-RPC 2.0 and HTTP+JSON interfaces, ensuring seamless integration with orchestration platforms.
PriorAI is designed with a strict clinical-first security model. We enforce a Zero-PHI (Protected Health Information) storage policy. All patient data processing is done in-memory within ephemeral sandbox environments. No patient records or generated prior authorization documents are ever persisted to disk.
Furthermore, all patient profiles used for testing, demonstrations, and validation are 100% synthetic, simulated using Synthea. PriorAI operates in absolute alignment with HIPAA requirements, securing physician peace of mind.
The HL7 Da Vinci Prior Authorization Support (PAS) Implementation Guide defines the FHIR-based standard for electronically submitting prior authorization requests. This bundle is structured per the PAS IG v2.0.1 specification, enabling direct payer system ingestion without manual data re-entry.
Ready for electronic submission to payer systems