Get Prior Authorizations Approved In Hours, Not Days
AI-powered prior auth automation that prepares complete submissions, anticipates payer requirements, and tracks every request in real-time — cutting turnaround from 10 days to 24 hours.
Auth approval rate
Average turnaround time
Reduction in phone/fax work
Average turnaround improvement
Prior Auth Is Broken — And It’s Costing You Patients and Revenue
A fully manual process designed in the fax era — consuming staff time, delaying care, and driving patients to competitors.
7–14 days
Average prior auth turnaround
Every day a patient waits for authorization is a day they might go somewhere else, cancel their appointment, or deteriorate clinically. Staff spend hours on hold.
3 FTEs
Average staff dedicated to prior auth at a 50-provider practice
Prior auth is entirely manual: calling payers, faxing documents, following up daily. At most practices, it consumes 2–4 full-time employees’ entire workday.
17%
Of authorized procedures never performed
Treatment delays from slow auths lead to patient abandonment, rescheduling, and clinical deterioration — turning approved auths into wasted administrative work.
End-to-End Prior Auth Automation
From requirement detection to approval tracking — every step of the prior auth lifecycle handled automatically.
Automated Auth Preparation
AI reads the clinical notes, identifies what’s needed for the auth request, and pre-populates the complete submission packet — clinical justification, diagnosis codes, supporting documentation.
< 5 min prep
Payer Requirement Intelligence
Knows exactly what each payer requires for each procedure — clinical criteria, documentation specifics, required forms. No more calling to ask what to send.
50+ payers
Real-Time Status Tracking
Track every open auth request in a live dashboard. Know exactly where each request stands, what’s pending, and when to expect a decision — without calling the payer.
Live status
Expiration Alerts
Automatic alerts when authorizations are approaching expiration, when decisions are received, and when requests need follow-up — zero items fall through the cracks.
Never miss a deadline
Clinical Justification Writer
AI generates a medically complete clinical justification letter based on the patient’s documentation — tailored to the specific payer’s medical policy for the requested procedure.
Payer-specific
Appeals for Denials
When a prior auth is denied, AI automatically generates the appeal package with clinical evidence, regulatory citations, and peer-to-peer review request if appropriate.
Integrated workflow
Auth Analytics Dashboard
See approval rates, turnaround times, denial patterns, and trending issues by payer, procedure, and physician — to identify and fix systemic problems.
Full visibility
Compliance Documentation
Every auth request, response, and communication is logged with timestamps and stored compliantly — creating a complete audit trail for billing and compliance.
Full audit trail
How It Works
From scheduling to billing — prior auth runs on autopilot in four steps.
Request Identified
When a procedure requiring prior auth is scheduled, NexaClaim automatically identifies the requirement, pulls the patient’s clinical history, and begins preparing the submission.
AI Prepares Submission
Within minutes, AI generates a complete auth request with clinical justification, supporting documentation, and all payer-required forms — ready for review and submission.
Automated Follow-Up
NexaClaim tracks submitted requests and automatically follows up with payers at defined intervals. Your team is alerted when action is needed, not for status checks.
Decision Tracked to Billing
When the auth is approved, the approval number and validity dates flow directly into the claim — preventing auth-related denials at submission time.
Real Practices. Measurable Results.
From cardiology to oncology — NexaClaim eliminates prior auth bottlenecks and gets patients to care faster.
Challenge
Auth turnaround averaging 9.3 days; 3 procedures/week delayed or cancelled due to auth delays; 1.5 FTE on auth full-time.
Result
Average turnaround 18 hours; procedure cancellations down 91%; 0.3 FTE now handles auth.
91% reduction in cancellations
Challenge
Aetna and UHC requiring increasingly complex auth submissions for joint replacements; team spending 4 hrs per request.
Result
AI-generated submissions accepted first-pass 94% of the time; auth prep time down to 12 minutes per request.
94% first-pass approval
Challenge
Chemotherapy regimen auths requiring peer-to-peer reviews 30% of the time; physicians losing 4 hrs/week to payer calls.
Result
AI-generated clinical justifications reduced peer-to-peer requests to 8%; physicians reclaimed 3.5 hrs/week.
73% fewer peer-to-peer calls
Auth approval rate
Average turnaround time
Reduction in auth call volume
Auth prep time (was 4 hrs)
Works With Your Scheduling and EHR System
NexaClaim connects to the systems your team already uses — no rip-and-replace, no long IT projects.
Frequently Asked Questions
Everything you need to know about NexaClaim’s prior authorization automation.
Stop Leaving Revenue on the Table
Join 50+ physician groups who have recovered millions in denied revenue with NexaClaim AI. Get started in 15 minutes with a free denial audit.
No credit card required. See results in under 24 hours.