Intelligent Prior Authorization

Automate the full prior authorization lifecycle so patients get the care they need faster.

Quisitive brings AI, automation, and Microsoft Cloud technologies together to transform prior authorization from an administrative burden into an autonomous, intelligence-driven workflow.

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Lead Type

From Administrative Burden to Autonomous Authorization

Manual, payer-by-payer workflows delay care, increase denials, and drain staff time. Patients wait. Providers get frustrated. Revenue takes a hit.

Healthcare leaders need a modern prior authorization process that increases speed, accuracy, and compliance.

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~14hrs

per physician per week is what providers spend on PA-related tasks (AAFP, 2023)

94%

of physicians say the PA process delays access to necessary care. (AMA, 2024)

33%

of physicians say that prior authorization delays have led to adverse events. (AMA, 2023)

What Intelligent Prior Authorization Delivers

AI + Microsoft Copilot + your existing systems

Solve what slows authorization approvals today

Manual data collection

Portal-by-portal submissions

Slow status updates and follow-ups

Payer variability and changing rules

High denial and appeal overhead

Replace manual effort with AI-driven workflows

Automated data extraction, validation, and normalization (FHIR/NLP)

Electronic prior auth (ePA) submissions through payer APIs or portals

Replace manual effort with AI-driven workflows

AI-generated appeal letters and clinical summaries

Configurable rules engine that adapts to payer changes

Full workflow auditability, transparency, and reporting

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Proven Impact for Healthcare Organizations

Modernized contact centers are proven to create more consistent patient access and experience.

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Approval times reduced from weeks to minutes

Lower first-pass denials through accurate, complete submissions

Operational savings from reduced manual hours

Measurable ROI in <90 days

Better compliance and visibility across the full PA lifecycle

Improved cash flow with fewer delays and fewer appeals

How it works

AI and automation are embedded into your EHR, access, and RCM workflows.

AI Data Ingestion

Extract eligibility and clinical data using NLP, FHIR, and payer rules.

Automated ePA Submissions

Submit requests through APIs or portals with complete, validated documentation.

Real-Time Status & Guidance

Monitor progress, detect missing information, and surface next actions.

AI-Assisted Appeals

Generate evidence-based appeal letters with contextual clinical summaries.

Continuous Learning

Adjust to payer rule changes without rebuilding entire workflows.

Quisitive Team Photo - smiling faces at a Quisitive led event

Why Healthcare Leaders Choose Quisitive

Built for healthcare - Over a decade supporting hospitals, imaging, and specialty care networks.

Microsoft expertise - Deep alignment with Dynamics 365, Teams, Copilot, Azure AI, and Cloud for Healthcare.

Modernization without disruption - Use the systems you already rely on. Automate where impact is the highest.

Measured improvements - Efficiency, access, revenue, and staff satisfaction gains within the first pilot.

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FAQ

Does this replace our existing prior authorization team or systems?

No. It automates the high-burden steps - data gathering, submissions, tracking, and appeals - inside the workflows your teams already use.

How quickly can we see results?

Does it integrate with our EHR and payer systems?

How do you handle payer variability and rule changes?

What results should we expect?