Pryzma Prior Authorization
AI-assisted prior authorization review that cuts turnaround time, improves approval accuracy, and gives clinical reviewers the evidence they need — before they ask for it.
The Problem
Prior authorization is the bottleneck that slows down care and burns out staff. Clinical reviewers manually pull patient records, cross-reference coverage policies, check medical necessity criteria, and document decisions — for every single request. Average turnaround times stretch to days. Denials get appealed. Peer-to-peer reviews pile up. And the whole time, patients wait. The process hasn't changed in decades, even as request volumes keep climbing.
How Pryzma Solves It
AI-Powered Clinical Assessment
Every incoming PA request is automatically assessed against coverage policies, medical necessity criteria, and clinical guidelines. The AI surfaces a confidence-scored recommendation — approve, deny, or escalate — with the specific criteria evaluation that supports the decision. Reviewers see the evidence before they open the chart.
Intelligent Review Queue
Requests are triaged and routed automatically. Straightforward cases with high AI confidence go through auto-approval. Complex cases route to clinical review with all supporting documentation pre-assembled. Urgent and emergent requests surface immediately. At-risk SLA cases are flagged before they breach.
Real-Time Analytics & Cost Intelligence
Track auto-approval rates, turnaround times, denial patterns, and SLA compliance in real time. Volume breakdowns by category, urgency level, and provider. Estimated cost savings from AI-assisted processing. Know exactly where your PA operation stands — not next month, right now.
Complete Audit Trail & Compliance
Every decision, every AI recommendation, every reviewer action is logged with timestamp, rationale, and supporting documentation. Full compliance with CMS interoperability rules and state PA reform requirements. Peer-to-peer review tracking, appeal management, and regulatory reporting built in.
How It Works
Example: What AI-Assisted PA Looks Like
A plan processing 1,250+ PA requests monthly would typically have reviewers spending most of their time on routine approvals — colonoscopies, standard imaging, medication refills that clearly meet criteria. With Pryzma PA, those straightforward cases auto-approve based on AI confidence scoring, freeing clinical reviewers to focus on genuinely complex determinations. The target: turnaround times measured in hours instead of days, auto-approval rates above 50%, and SLA compliance that stays above 95% without burning out your review staff. Every recommendation comes with the criteria evaluation that supports it — so when a reviewer does intervene, the evidence is already assembled.
See Authorization in Action
We'll walk you through a live demonstration with your compliance requirements and data environment.
Schedule a Demo