Agentic AI for prior auth and front desk to clear patients for care before they arrive
Our specialized healthcare AI agent force verifies eligibility, catches registration errors, builds the prior auth packet against the payer's own rules. Your team only gets the cases that need manual work.
Your front office gets its day back to turn more of your prior auths into revenue.
Receive a prior auth proposal in 48 hours →
HealthIntellix is a specialized healthcare agentic force,
developed by GoML
We understand your prior auth and front desk pain points, thoroughly
"How many claims did we lose this month to a typo at check-in?"
Registration and eligibility errors at your front desk are a massive bottleneck due to manual data entry. It's hard to discover this mistake until the claim is denied.
Errors are flagged much sooner and eligibility is directly verified at scheduling. This includes State IDs and DOB mismatches. Authorization requirements are identified before the patient walks in.
"Why are our coordinators spending a day and a half every week on hold with payers?"
Another huge drain is prior authorization. An average of 13 hours of staff time per physician is spent on authorization related work.
The need for an auth is decided by procedure code, the chart is matched against the payer's own versioned rules, and a standard Da Vinci PAS packet is assembled for your coordinator to review and send.
"Who is watching the authorization after it gets approved?"
You know that an approval is not the finish line. Coverage can lapse, the patient's plan can change or the procedure can change before the visit. If no one catches it, you can deliver the care, only to have the claim denied afterward.
Every approved auth is watched for 14 days for coverage and clinical status changes, and your team is alerted in time to re-verify or re-authorize before the date of service.
The ROI of a Self-Clearing Front Office Can Save Your Team upto 4 Hours/Day
Hours on hold with payers. Days waiting on a single authorization.
Access team
- Eligibility checkManual portal lookup
- Stale ID, DOB mismatchFound on the denial
- Is an auth required?Coordinator checks payer grid
- Auth packetBuilt by hand from chart and fax
- Referral fax and voice intakeRe-keyed by staff
- After approvalNo one watching
- Sign-offOften informal
Agentic clearance
- Eligibility checkReal time, at scheduling
- Stale ID, DOB mismatchCaught at registration
- Is an auth required?Decided by procedure code
- Auth packetDa Vinci PAS, criteria matched
- Referral fax and voice intakeIngested and structured
- After approval14-day monitoring regime
- Sign-offExplicit human approval
HealthIntellix clears patients and authorizations upstream, preventing denials and delays.
Clear every visit before the patient walks in.
Let agentic AI do the chasing.
The patient access and prior authorization agentic force is one function under HealthIntellix - four specialized systems, wired into one closed feedback loop.
With HealthIntellix by your side, your front office can close the loop on every visit - verify, clear, authorize, watch and learn.
Intake & Real-Time Eligibility
Data
Referral faxes and voice intake, demographics, member and ABHA IDs, and live payer eligibility responses for every scheduled encounter.
Mechanism
Data-quality gates flag stale IDs, DOB mismatches and coordination-of-benefits conflicts, and stamp an auth-required flag on the encounter.
Engineering loop
Every payer response teaches the system which fields fail for which payer, so the next registration is checked against it first.
Financial Clearance
Data
Guarantor details, primary and secondary coverage, encounter type, point-of-service estimates and consents.
Mechanism
A guided agentic workflow with each stage pre-filled and verified before a human signs off.
Engineering loop
Patients reach the desk already cleared, with their estimate and consents in hand.
Prior Authorization
Data
Procedure codes, chart documentation and versioned payer policy rules expressed as logic.
Mechanism
Decides whether an auth is needed, matches the chart to the payer's criteria and assembles a standard Da Vinci PAS Claim packet. On the payer side, the same rules drive an adjudication worklist with SLA timers.
Engineering loop
Every payer decision is captured against the rule version it was made under. Agents learn from each decision.
Authorization Status Watcher
Data
Approved authorizations, live coverage status and changes to the planned procedure, units or site of care.
Mechanism
Watches every approved auth for 14 days for coverage and clinical status changes, and raises a re-verify or re-auth task before the date of service.
Engineering loop
Payer auth reversal and denial patterns feed back into clearance, so high-risk auths are re-checked earlier.
"GoML is our strategic partner in building the layer of Generative AI that helps our teams analyze and interact with the broad set of clinical data we collect on every member of our preventative health practice. Further, it is essential with such a rapidly evolving landscape to ensure that we get the right thought leadership to immediately implement new architectural or design patterns in generative AI, and GoML has delivered on this promise as well."
Why lose a day and a half every week to paperwork? Get started with HealthIntellix now
HIPAA compliant · ISO 27001 certified · No PHI required to scope an engagement.
