Prior Authorization Automation
Automate prior authorization across provider and payer systems.
Unifhi connects the EHR, payer, and supporting systems already in place. It brings requirements, documentation, status, and exceptions into one governed workflow — without replacing your existing platforms.
Reduce manual handoffs, give every request a clear owner, and see where delays are affecting care and revenue.
The Challenge
Prior authorization is not one task. It is a workflow spread across systems.
Requirements vary by payer, plan, procedure, and site of service. Clinical information lives in the EHR; decisions arrive through portals, APIs, transactions, and fax. Staff hold the process together with spreadsheets, inboxes, and repeated follow-up.
Incomplete requests
Missing documentation, inconsistent data, and changing payer requirements create avoidable rework before a request can move forward.
Invisible delays
Teams struggle to see which requests are waiting, why they are waiting, and who owns the next action.
Financial exposure
Authorization delays can disrupt scheduling, delay services, contribute to downstream denials, and put expected revenue at risk.
The Solution
One coordinated prior authorization workflow across the systems you already use.
Unifhi does not replace your EHR or payer platforms. It connects their data and manages the rules, handoffs, and exceptions that cross them.
Organize intake
Bring patient, coverage, order, procedure, diagnosis, and supporting information into a consistent workflow.
Apply and validate requirements
Configurable payer- and procedure-specific rules determine what each request needs — missing or inconsistent information is routed to the right owner early.
Track status and aging
Maintain a shared view of request status, elapsed time, ownership, and outstanding actions across the authorization lifecycle.
Route exceptions
Separate routine processing from the cases that require clinical, administrative, or payer follow-up.
Workflow
From request to resolution.
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01
Connect the required data
Receive clinical, administrative, and coverage information from the EHR, payer, and supporting systems through interfaces, APIs, transactions, and file exchanges.
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02
Apply approved rules
Evaluate the request against configured requirements for the payer, plan, procedure, and organizational workflow.
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03
Coordinate the next action
Advance complete requests, route missing information, assign exceptions, and preserve the context associated with each case.
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04
Monitor the lifecycle
Track status, aging, ownership, responses, and unresolved work in one operational view.
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05
Improve the process
Analyze recurring delays, missing information, payer patterns, and workflow outcomes. Refine the approved configuration as requirements change.
Prior Authorization Intelligence
See where the workflow is breaking — and what it is affecting.
Unifhi connects authorization activity to operational and financial context so teams can answer:
- How many requests are open, pending, completed, or delayed?
- Where are requests aging?
- Which payers, procedures, locations, or service lines create the most rework?
- What documentation is most often missing?
- Which exceptions require immediate attention?
- What scheduled services or expected revenue may be affected?
- Did a workflow or rule change improve turnaround time?
Prioritize work by urgency and potential impact — not queue order alone.
Configuration and Governance
AI accelerates configuration. Approved rules control execution.
Unifhi uses implementation guides, payer specifications, and your operating rules to generate mappings, validations, and workflow definitions. Your experts review and test the configuration before it is used.
In production, deterministic engines execute the approved configuration consistently. AI does not improvise authorization decisions or replace the clinical and administrative judgment required for exceptions.
Why Unifhi
Built for the way authorization actually works.
Work with existing systems
Keep your EHR, payer connections, portals, and supporting applications. Unifhi coordinates the work between them.
Adapt to payer variation
Configure requirements and exception paths by payer, plan, procedure, location, or workflow.
Keep people in control
Automate repeatable processing while routing clinical and administrative judgments to qualified staff.
Preserve traceability
Connect source data, applied rules, workflow actions, responses, and decisions throughout the authorization lifecycle.
FAQ
Prior authorization questions
Does Unifhi replace our EHR or payer portal?
No. Unifhi connects the data and work that cross those systems. The EHR remains the clinical system of record, and payer systems continue to provide requirements and decisions.
Can Unifhi submit prior authorization requests electronically?
Unifhi supports electronic exchange through interfaces, APIs, healthcare transactions, and file connections. The submission method depends on the payer, EHR, clearinghouse, and endpoints in a given implementation.
How does Unifhi handle different payer requirements?
Payer- and procedure-specific requirements are represented as governed configuration. Teams can review, test, and update the relevant mappings, validations, and workflow rules as requirements change.
Does AI make authorization decisions?
No. AI accelerates the creation of configuration from specifications and requirements. Approved rules drive production execution, while qualified staff retain control of clinical judgments, approvals, and exceptions.
What standards can Unifhi work with?
Unifhi supports healthcare integration through HL7 v2, FHIR, X12, CDA, REST APIs, SFTP, and flat-file exchanges. The specific combination depends on the participating systems and workflow.
Can we start with one authorization workflow?
Yes. Unifhi can begin with a defined payer, service line, procedure group, or operational team and extend to additional workflows over time.
Related Solutions
Bring your prior authorization workflow into one connected process.
Tell us where requests slow down, information goes missing, or staff lose visibility. We will map the systems, requirements, handoffs, and exceptions involved.