PRIOR AUTH AND ELIGIBILITY
Prior auth that clears itself before the patient arrives.
Agents verify benefits, read payer policy, assemble medical necessity from the chart, submit, and track every request to a decision. Your staff only sees what needs a human.
5,800
eligibility checks a month with zero staff touch
82%
return complete benefits, written back to the EMR
~580
staff hours returned a month, the capacity of about 3–4 full-time staff
6 weeks
from kickoff to prior auth live
One cardiology practice, 20 physicians. Hours: ~5,800 checks a month × ~6 minutes saved each; full-time staff at ~160 hours a month.
HOW IT WORKS
Four steps, one closed loop, back in your chart.
- Verify Eligibility and benefits checked as soon as the visit is scheduled, and written back to the chart.
- Check policy The policy agent matches the order to the payer’s rules and builds the medical-necessity checklist.
- Submit Clinicals pulled from the chart, submitted electronically, or by fax where a payer still requires it.
- Track and close Status followed to a decision; the outcome lands in the EMR and the schedule moves on.
ROLLOUT
Live in six weeks, starting in shadow mode alongside your team.
STAGE 1
Shadow
Agents work every request alongside your team. Nothing is submitted; you compare results.
STAGE 2
Assisted
Agents prepare each request; your staff reviews and approves with one click.
STAGE 3
Autonomous
Clean requests flow straight through. Your team handles exceptions only.
READY FOR 2027
Ready for the standards payers are now required to support.
CMS’s Interoperability and Prior Authorization rule (CMS-0057-F) requires impacted payers to support prior auth APIs from 2027. ColigoMed uses X12 278 and FHIR today, works payer portals with AI where there is no API, and is ready to adopt the new payer APIs as they open.
- FHIR
- X12 278
- Payer portal automation
- EMR write-back
- Epic
- athenahealth · eClinicalWorks
Questions practices ask
Do we have to change our EMR or workflow?
No. ColigoMed connects to your existing EMR and writes results back into it. Staff keep working where they work today.
What about payers that still use fax?
The fax automation agent sends, reads and files fax responses, so those payers are tracked like everyone else.
Who reviews what the AI submits?
You decide. Every practice starts in shadow mode, then assisted, and moves to autonomous only when the results earn it. Anything uncertain goes to a person.
Is our data secure?
ColigoMed is SOC 2 Type II and HIPAA compliant, and signs a business associate agreement with every customer.