Dan Nandan is the President and CEO of Staffingly, Inc. With 25+ years across IT consulting, healthcare BPO operations, and AI automation, he was one of the earliest U.S. operators to set up an RPO/BPO delivery network in India over 20 years ago. Today his work centers on production AI deployments inside healthcare practices, hospital systems, and pharmacy networks across North America.
Experienced AI Prior
Authorization Automation Outsourcing Services
4.9
★★★★★
Google Rating
AI Prior Authorization Automation
Amazon Bedrock extracts clinical criteria from the chart, drafts the prior authorization, and submits it to the payer portal. Licensed pharmacist reviews complex cases (chemo, biologics, surgical). CMS-0057-F API ready. Our staff work from secured facilities in India, Pakistan, and Bangladesh.
Get a Free
Workflow Analysis
Tell us your workflow. We’ll project your savings in 24 hours.
Single specialty or multi-site? One workflow or full revenue cycle? Send us your situation. We map the right AI automation mix.
Quick Answer
What Is AI Prior Authorization Automation?
What is AI prior authorization automation? AI prior authorization automation is a workflow that extracts clinical criteria from the patient chart, drafts the prior authorization, and submits it to the payer portal. The Staffingly platform runs on Amazon Bedrock for criteria extraction. A licensed pharmacist reviews complex cases including chemotherapy, biologics, and surgical PAs. HIPAA-compliant with BAA day one and CMS-0057-F API ready.
The 2024 AMA Prior Authorization Physician Survey reported that physicians spend roughly 13 hours per week on prior authorization work. CMS estimates the administrative cost at approximately $34,000 per provider per year and roughly 700 hours of staff time. The Staffingly workflow pulls the criteria from the chart, drafts the PA against the payer’s actual medical policy, and submits through the portal or the CMS-0057-F FHIR API where the payer has stood it up.
Standard PA decisions are returned within 7 calendar days under the CMS rule for impacted payers. Urgent PAs are returned within 72 hours. Staffingly’s draft and submission step typically completes inside one business day for standard, same day for urgent. The pharmacist sign-off layer catches the high-risk cases before they leave the building.
Most practices pair PA automation with AI insurance eligibility verification, denial management and appeal drafting, and document and fax processing to run revenue cycle end-to-end.
HIPAA + BAA day 1
AI + human review
Inside your EMR
Key Takeaways
What you need to know about AI prior authorization
01
AMA 2024 data shows physicians spend about 13 hours per week per provider on prior auth. CMS estimates roughly $34K and 700 staff hours per provider per year. Automation handles the criteria extraction, draft, and submission steps. Numbers reflect industry data, not guaranteed outcomes.
02
Amazon Bedrock handles clinical criteria extraction from the chart. A licensed pharmacist signs off on complex cases including chemotherapy, biologics, infusions, and surgical PAs. Routine cases are reviewed by a healthcare-trained specialist.
03
CMS-0057-F ready. Standard PA decisions return within 7 calendar days under the rule for impacted payers (Medicare Advantage, Medicaid managed care, CHIP, FFE QHPs). Urgent PAs return within 72 hours.
The Challenge
Why has prior authorization become the single biggest admin tax on a practice?
Prior authorization is a 13-hour-per-week-per-provider tax according to the AMA 2024 survey. The cost works out to about $34,000 per provider per year in administrative time alone. The work is split between criteria extraction, draft, submission, status tracking, and appeal. Each step is doable for a human. Doing all five for every PA across a panel of providers is what breaks the team. Urgent PAs missed inside the 72-hour window cost the patient. Denials that fall off the work list cost the practice. The fix is to extract the clinical criteria from the chart with an LLM, draft the PA against the payer’s actual medical policy, route it through a pharmacist on the complex cases, and submit through the portal or the CMS-0057-F FHIR API as those go live.
Our Approach
How is Staffingly’s AI prior authorization different?
STEP 01
Bedrock Criteria Extraction
Amazon Bedrock pulls clinical criteria from the chart. Diagnosis, prior failed therapy, labs, imaging, prescriber notes. Output is structured against the payer’s policy schema.
STEP 02
Pharmacist Sign-Off
Licensed pharmacist reviews complex cases including chemotherapy, biologics, infusions, and surgical PAs before submission. Audit trail captures reviewer, draft text, and submission timestamp.
STEP 03
CMS-0057-F Ready
FHIR-based PA APIs are wired in as impacted payers (Medicare Advantage, Medicaid managed care, CHIP, FFE QHPs) bring them online. Portal fallback runs everywhere else.
STEP 04
Appeal Letter Drafting
Denials draft a first-pass appeal against the payer’s actual medical policy. The pharmacist reviews clinical denials before the appeal is filed.
STEP 05
Status Tracker
Every PA tracked from submission to decision. Urgent PA timers visible. Missed-deadline alerts. Status pulled from the payer portal or FHIR API depending on the payer.
STEP 06
Payer Policy Library
Maintained library of payer medical policies, formularies, and step-therapy rules. The PA draft is anchored to the controlling document for that payer.
STEP 07
HIPAA + BAA Day 1
BAA before kickoff. Chart data masked per Safe Harbor. SOC 2 Type II, ISO 27001, HITRUST CSF aligned.
STEP 08
Toggle On or Off Anytime
Manual fallback in minutes. The 6-week phased rollout means there is always a fallback path. Revert any phase to fully manual without contract penalty.
AI + AUTOMATION
AI + Automation in prior authorization
Prior authorization has predictable structure. Same payer policies, same chart fields, same step-therapy logic. Amazon Bedrock handles the criteria extraction and draft. A licensed pharmacist handles the complex cases. The combined workflow moves the bulk of the 13-hour weekly per-provider load off the clinical team.
Criteria extraction
Bedrock pulls diagnosis, prior failed therapy, labs, imaging, and prescriber notes from the chart. Output is structured to the payer’s policy schema.
Payer-policy lookup
The PA draft is anchored to the controlling payer medical policy, formulary entry, and step-therapy rule. Citations included on the draft.
Confidence-based pharmacist handoff
Complex cases (chemo, biologics, surgical) route to a licensed pharmacist before submission. Routine PAs route to a healthcare-trained specialist.
HIPAA-compliant
SOC 2 Type II
ISO 27001
100% human reviewed
The Workflow
How does the AI prior authorization deployment work?
01
Discovery + PA audit
Days 1-3. PA volume, top drugs and procedures, payer mix, EMR setup, denial reason history, and current PA workflow audited.
02
Bedrock + policy library build
Days 4-10. Bedrock configured for your top PA types. Payer policy library loaded for your top ten payers. Portal credentials vaulted. CMS-0057-F endpoints registered where available.
03
Observer mode
Days 11-14. Workflow drafts every PA against the live queue but only writes to a shadow record. Pharmacist reviews the draft quality. Thresholds tuned.
04
Assisted mode
Weeks 3-4. Workflow drafts and submits. Each PA reviewed by a human before submit. Confidence visible per case. Flag-and-escalate built in.
05
Supervised autonomous
Weeks 5-6+. High-confidence routine PAs auto-submit. Complex PAs queue for the pharmacist. Toggle on or off any time.
06
Performance tracking
Weekly KPI dashboard. PAs drafted, PAs submitted, approval rate, denial reasons, urgent-PA cycle time, appeal win rate, pharmacist escalation rate.
Pricing varies. Starts at $0.25 per minute of automation time per authorization, plus $399 per week for the dedicated FTE, plus a one-time setup fee based on EMR integrations and other workflows. Final scope and pricing confirmed during your discovery call. Numbers shown reflect typical pilot deployments and AMA 2024 survey data, not guaranteed outcomes.
Pricing
What is the cost of AI prior authorization?
What does AI prior authorization cost? Pricing varies. Starts at $0.25 per minute of automation time per authorization, plus $399 per week for the dedicated FTE, plus a one-time setup fee based on EMR integrations and other workflows.
Three things drive the final number: weekly PA volume (driven by specialty and panel size), the EMR integration package, and the payer mix (some payers require portal handling, others publish a CMS-0057-F endpoint). Pharmacist review is included on complex cases. Multi-location and white-label deployments are quoted separately.
The pricing calculator gives an estimate in about a minute. Drop in your weekly PA volume, your top three drug or procedure categories, and your top three payers to see a working number before the discovery call.
Service Areas
Where can you deploy AI prior authorization?
The PA workflow runs anywhere a payer requires authorization. Specialty configuration covers medical, dental, pharmacy, veterinary, eye care, home care, ambulatory surgery, and hospice practices. Cross-vertical deployments are supported for multi-location groups, DSO and MSO networks, PE-backed roll-ups, and hospital systems.
Healthcare practices across California, Texas, Florida, New York, Illinois, New Jersey, and every other state run the Staffingly PA workflow. State Medicaid managed care plans are wired in per engagement, including the impacted payer set under CMS-0057-F.
FAQ
What are the most common questions about AI prior authorization?
What is AI prior authorization automation?
AI prior authorization automation is a workflow that extracts
clinical criteria from the patient chart, drafts the prior
authorization, and submits it to the payer portal. The Staffingly
platform runs on Amazon Bedrock for criteria extraction. A
licensed pharmacist reviews complex cases including chemotherapy,
biologics, and surgical PAs. HIPAA-compliant with BAA day one and
CMS-0057-F API ready.
How much time does it save providers?
The 2024 AMA Prior Authorization Physician Survey reported about
13 hours per week per provider on prior authorization. CMS
separately estimates the administrative cost at roughly $34,000
per provider per year and approximately 700 staff hours.
Automating the criteria extraction, draft, and submission steps
cuts the bulk of that time. Numbers reflect industry data and
internal pilot data, not guaranteed outcomes.
What is CMS-0057-F?
CMS-0057-F is the federal interoperability and prior authorization
rule that binds Medicare Advantage, Medicaid managed care, CHIP,
and federally facilitated exchange QHPs to use FHIR-based prior
authorization APIs for in-network items and services. The
Staffingly workflow is built to call those APIs as they come
online with each impacted payer.
What is the turnaround time on a PA?
Standard prior authorization decisions are returned by impacted
payers within 7 calendar days under the CMS rule. Urgent prior
authorizations are returned within 72 hours. Staffingly’s draft
and submission step typically completes inside one business day
for standard PAs and same day for urgent.
Does a human review the prior authorization?
Yes. A licensed pharmacist reviews complex cases including
chemotherapy, biologics, infusions, and surgical PAs before
submission. Routine PAs are reviewed by a healthcare-trained
specialist. Every PA carries an audit trail showing extraction
source, draft text, reviewer, and submission timestamp.
Can it draft appeal letters on denials?
Yes. The workflow drafts a first-pass appeal letter using the
payer’s actual medical policy as the controlling reference. The
pharmacist reviews clinical denials before the appeal is filed.
Status of every appeal is tracked in the dashboard.
Is the workflow HIPAA compliant?
Yes. HIPAA-compliant workflows, SOC 2 Type II certified, ISO 27001
certified, HITRUST CSF aligned. BAA signed before day one. Chart
data is masked per the HIPAA Safe Harbor 18-identifier standard
before any analytics run.
How long does deployment take?
Most practices go live in 14 days. Days 1-3 we audit your PA
volume, top drugs and procedures, payer mix, and EMR. Days 4-10
the Bedrock criteria extraction and payer policy library are
configured. Days 11-14 the workflow runs in observer mode
shadowing your team.
What does AI prior authorization cost?
Pricing varies. Starts at $0.25 per minute of automation time per
authorization, plus $399 per week for the dedicated FTE, plus a
one-time setup fee based on EMR integrations and other workflows.
Use the
pricing calculator
for an estimate or book a discovery call.
One More
Step
Talk to a real human about your AI Prior Authorization Workflow
30-minute strategy call. We scope your PA volume, top drugs and procedures, and payer mix, then recommend the right Bedrock configuration. No slide deck, just a working plan.
