An AI-powered solution that automates prior authorizations from eligibility detection to appeals, helping health systems reduce admin burden, accelerate patient care, and prevent denials.

Innovaccer Inc., a leading healthcare AI company, today announced the launch of Flow Auth, an AI-powered prior authorization solution, that is part of Flow by Innovaccer, the company's revenue cycle performance platform. Flow Auth automates the entire prior authorization workflow, from detecting authorization needs to generating appeal letters, with intelligent exception handling that keeps humans in the loop, helping healthcare organizations accelerate care delivery and optimize revenue capture. With Flow Auth, Innovaccer projects an estimated 50% reduction in clinician time spent on prior authorizations and a twofold increase in staff productivity, with projected ROI of up to 5x through efficiency gains and reduced denials based on initial implementations¹.

The AMA’s 2024 Prior Authorization Physician Survey shows the scale of the problem, 94 percent of physicians say prior authorization delays care, 27 percent report requests are often or always denied, and 89 percent link the process to increased burnout. Flow Auth tackles these challenges directly by automating the workflow end to end, reducing delays, lowering denial rates, and easing the administrative load on clinical teams.

Currently, according to a CAQH report, about 30% prior authorizations can be sent electronically; the remaining majority are processed through fax, payer portals, or phone calls, creating inefficiencies that impact both patient outcomes and health system performance. Flow Auth leverages an end-to-end automation framework powered by a seamlessly integrated ecosystem of AI Agents. It streamlines relevant stages of the PA process, from eligibility verification and submission to appeals, while adhering to payer-specific guidelines. This enables faster approvals, reduced revenue delays, and lowers manual workload, enabling submissions to meet requirements the first time.

Key features include:

• Proactive PA Detection: Automatically identifies when prior authorization is required when an order is placed in the EHR, based on payer-specific criteria.
• Integrated Payer Rules: References the latest medical necessity guidelines for each payer, ensuring accurate submissions the first time.
• Payer-Ready Packet Creation: Automatically assembles relevant clinical documentation, notes, labs, and imaging, flagging any missing items, and organizing them in the format payers expect.
• Full-Spectrum Submission: Sends packets using the full range of payer connectivity options, APIs, portals, or fax.
• Real-Time Tracking: Monitors authorization status and provides updates within the clinical workflow.
• Automated Appeals Drafting: Helps streamline appeals by drafting a letter for denied requests using historical outcomes and payer-specific policies, auto-filling required clinical details.

Flow Auth is designed keeping in mind the current systems in the marketplace, making it highly compatible with the existing systems. It integrates seamlessly with major EHRs and payers. Innovaccer has the ability to add new payers based on customer needs so prior authorizations can be automated across their entire payer mix.

“Prior authorization should never stand between a patient and the care they need,” said Abhinav Shashank, cofounder and CEO at Innovaccer. “Every day lost to paperwork is a day a patient waits in uncertainty. Flow Auth changes that by removing the administrative roadblocks substantially. It keeps the process invisible to patients, effortless for providers, and always aligned with the latest payer requirements. This is about giving clinicians back their time and patients back their speed to care.”

The solution supports a wide range of major payers, including Humana, UnitedHealthcare, Blue Cross Blue Shield, Anthem, Aetna, and others, enabling broad coverage and streamlined workflows across diverse payer networks.

About Innovaccer

Innovaccer activates the flow of healthcare data, empowering providers, payers, and government organizations to deliver intelligent and connected experiences that advance health outcomes. The Healthcare Intelligence Cloud equips every stakeholder in the patient journey to turn fragmented data into proactive, coordinated actions that elevate the quality of care and drive operational performance. Leading healthcare organizations like CommonSpirit Health and Banner Health trust Innovaccer to integrate a system of intelligence into their existing infrastructure, extending the human touch in healthcare. For more information, visit innovaccer.com.

¹Based on internal estimates

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