Automate prior authorization
Unstract reads each physician's order and the chart behind it, checks that the documentation the payer's criteria ask for is there, assembles the request and tracks the payer's decision. The payer decides; your coordinators see only the requests that need a person.
Trusted by healthcare and revenue cycle teams around the globe
The order is in the EHR, the evidence is scattered
A physician signs an order for an MRI or an infusion. The payer wants a filled form, the right codes and proof from the chart, and a coordinator pulls notes, faxes and reports by hand while the scheduled date gets closer.
A payer form keyed by hand while the scan date gets closer
A faxed clinical note, skewed, with the stamp over the visit date
A CPT code on the request that doesn't match the order
A pended request nobody saw until the denial arrived
The same MRI request sent twice by two staff members
Each request needs the order, the codes and the right pages of the chart matched to one payer's rules before anyone can submit it.
Unstract reads the order and the chart, checks that the documentation the payer asks for is present, and assembles the request. A coordinator or a nurse reviewer sees only the requests with a gap or an urgent date.
From the physician's order to the EHR, without the keying
Five steps, run on their own for every prior auth request. Parsing by LLMWhisperer, extraction by Document Studio, the whole run by Flow.
Pick up the order and its records wherever they land
Orders arrive from the EHR order queue, referrals come in by fax, and clinical notes, imaging reports and insurance details sit in the chart or arrive as scans from the front desk. Each one is picked up and tied to the patient, the payer and the ordered service, one request per order.
The run starts when the order is signed, not when someone notices it in a queue.
Read every order and note, then pull the fields the payer asks for
LLMWhisperer reads each order, faxed note and report as text with its layout kept, so a skewed fax or a handwritten referral comes through as cleanly as a typed order. Document Studio then extracts the fields you defined: patient, payer and member ID, CPT and ICD-10 codes, the ordering provider and NPI, and the clinical facts the payer asks about, such as prior treatment and its dates.
The same field definitions run on every order, whichever clinic or fax machine it came from.
Check it against the payer's criteria before anyone touches it
Each request is checked against that payer's rules for the service: whether authorization is needed at all, whether the member is eligible, whether the codes match the documentation, and whether the chart holds the documentation the criteria ask for. This check looks for what is on file. It does not judge clinical appropriateness, and the payer makes the medical-necessity decision.
A missing document, an unmet criterion or an urgent case stops for a prior authorization coordinator or a nurse reviewer, with the gap shown beside the chart.
Assemble the payer's form and submit the request complete
The payer's request form is filled from the extracted record, the supporting pages from the chart are attached, and the request is submitted through the payer's portal, as configured for each of your payers. Every field the form asks for is filled before it goes, so the payer has no reason to pend it for missing information.
The packet is built the same way for every request, so a busy week doesn't produce thin submissions.
Post every decision where the authorization team already works
Each request is tracked against its scheduled date. Approvals post to your EHR, such as Epic or Oracle Health, and to the practice management system with the authorization number and its valid dates. Denials go to the coordinator for appeal, with the payer's reason and the packet that was sent.
A request that sits without an answer close to its date is raised before the patient arrives.
Watch a week of your own orders go through.
Bring the orders from one service line, imaging or infusion, with the notes that went to the payer. You see each request read, checked against that payer's criteria and assembled.
Everything that goes into a prior authorization request
Documents
- Physician orders
- Clinical notes
- Radiology reports
- Insurance verification forms
- Referral forms
- Payer prior authorization request forms
- Lab results
- Payer denial letters
Fields captured
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Live on one service line first
Your coordinators describe how requests work today, and the run is built and tested on your own orders and payers before it covers more services.
Book a consultation
We go through a week of your orders together: which services need authorization, which payers you send to, and where requests get pended or denied today.
Built on your documents
The fields, each payer's documentation criteria and the connection to your EHR are set up on your own orders and charts, not samples.
Pilot on one service line, then roll out
One service line, such as imaging, runs live first. When the numbers hold, other services and payers follow, and the hold rules carry over.
Built for the teams that get services authorized
Prior authorization automation that builds each request from the order and the chart, so the day goes to the requests with a gap.
Only the requests where the documentation falls short of the payer's criteria or the case is urgent, with the chart pages beside them.
Fewer denials for missing information, and an authorization number on record in your EHR or practice management system before the claim goes out.
Requests for scans, infusions and procedures submitted complete, each payer's rules kept apart, and approvals tracked against the schedule.
Requests assembled in minutes, gaps caught before submission
Safe to run the clinical records you send to payers
A prior authorization request carries the patient's diagnoses, treatment history, imaging findings and member ID, and every request sends those clinical records outside your organization to a payer.
- Encrypted in transit and at rest.
- Orders, notes and requests are never used to train models.
- Access by role and service line, with every review and correction recorded against the request.
- Retention you set: processed records are deleted on the schedule you choose.
- Self-hosted deployment for organizations whose policies keep patient records on their own infrastructure.
What authorization teams ask before they start
Unstract uses two layers. LLMWhisperer reads each form, order and faxed note as text with the layout kept, including checkboxes and handwriting. Document Studio then pulls the fields each payer's form requires, such as member ID, CPT and ICD-10 codes and the ordering provider's NPI, into one record, with a confidence score on every value.
Document Studio runs as an API. Post a combined PDF, and the request form, the order, the clinical notes and the reports come back as separate documents, each with its own extracted fields. A faxed packet with no cover sheet is split the same way.
The same Document Studio API. You define the fields once, and every payer's form layout returns the same record: patient, payer, codes, provider, requested service and units. Records go to your EHR or a database, or run straight into the full request process in Flow.
No. The payer decides, and Unstract does not make medical-necessity decisions or guarantee approvals. Automated prior authorization here means the request is built, checked for the documentation the payer's criteria ask for and submitted complete. Whether the care is clinically appropriate stays with your clinicians and the payer.
Whether that payer requires authorization for the service, whether the member is eligible, whether the CPT and ICD-10 codes match the documentation, and whether the chart holds what the criteria ask for, such as weeks of prior therapy or an earlier imaging report. Prior auth automation stops a request with a gap instead of sending it thin.
They go to a prior authorization coordinator or a nurse reviewer. The review screen shows the payer's criterion, what the chart documents and the order side by side. The reviewer attaches the missing notes or queries the physician, and every other request keeps moving.
Each payer's rules and portal submission are configured for the payers you send to. Approvals and authorization numbers post to your EHR, such as Epic or Oracle Health, and to your practice management system through the connection set up for your organization.
Unstract is SOC 2, ISO 27001, GDPR and HIPAA compliant. Records are encrypted in transit and at rest, never used to train models, and kept only as long as you choose. Access is set by role, and each review is recorded against the request. Controls and reports are in the Trust Center.
Bring a week of orders to the consultation
Orders from one service line, with the faxed notes and the payer forms that went with them. You see each request read, checked and assembled, and where it stops for a nurse reviewer.