Integrated AI Agents That Automate Prior Auths for Health Plans

Automate prior auths with AI agents that integrate seamlessly with your Utilization Management software. We handle intake, compare requests to criteria, and determine whether to approve, deny, or send for outreach.

Built from ground up by AI engineers, doctors, and pharamcists to automate cases while giving you the flexibility to integrate with your existing UM systems.

End-to-End Automation for Prior Auths

Case Health AI uses proprietary AI models that work together seamlessly to handle intake, verify provider documents against criteria, and determine whether to approve, deny, or send for outreach.

Intake prior auth - CALLM™
Intake prior auth - CALLM™

The Clinical Abstraction LLM extracts key information from any prior authorization document, including patient, provider, prescribed drug or service, and supporting diagnosis.

Evaluate case - EVALLM™
Evaluate case - EVALLM™

Our Evaluation LLM verifies provider documents against criteria, claims history, and payer rules to determine coverage.

Send for approval, denial, or outreach
Send for approval, denial, or outreach

Approved cases can be sent for approval. Denied or incomplete cases return to your UM system for manual review with all intake details and criteria summaries.

How our Powerful Proprietary AI Models Deliver Clinically Accurate Results

Case Health AI models are trained on CMS guidelines, integrated with leading compendiums, and built by clinicians to ensure clinically accurate approvals or denials, with a complete audit trail.

1. Intake extracts every detail

Our Intake Agent, powered by CALLM™, quickly extracts every detail from a prior auth request—including codes, provider and patient info, and messy handwriting—and creates a complete case summary in under two minutes. It even detects duplicates automatically.

2. Evaluate against criteria

We evaluate each case using the health plan’s criteria, trusted compendiums, and the patient’s full history—including prior claims, medications, services, and past prior authorizations—powered by EVALLM to determine whether it should be approved, denied, or sent for outreach.

Approved, Denied, or Outreach

We send the final determination to your UM system. Approved cases can be sent for automatic approval, while denied cases go to a clinician for manual review. Intake details and criteria checks are included to help clinicians verify the AI’s decision quickly and accurately.

Faster Claim Decisions. Proven Results.

Our AI agents reduce friction across every step of the authorization process—cutting processing times, improving approvals, and reducing manual work. Here's what our partners have seen:

95%

Faster intake processing

30%

Fewer mistakes due to human error

1.5min

Average time to process a prior authorization claim

Instantly turn messy policies into smart decision trees

Upload a policy in PDF or plain text — our AI parses and converts it into a structured, editable decision tree in seconds. Whether it's step therapy, tier restrictions, or prescriber rules, our system breaks it all down into clear, customizable logic blocks you can edit anytime.

Turn Complex Policies into AI-Ready Decision Trees

Upload your prior authorization policies in PDF or text format. CHAI's AI engine will instantly convert them into structured, editable decision trees — built for speed, accuracy, and compliance. No more manual logic mapping.

Editable & Transparent Logic

Every branch in the tree is fully customizable — update conditions, reword questions, or insert new criteria anytime. Maintain control without starting from scratch.

Built for Clinical Automation

Our AI agents use these trees to make real-time decisions. Whether it's verifying coverage rules or generating approval/denial letters, you get end-to-end automation that's explainable and auditable.

Prior Authorization AI Transformation
AI for Prior Authorizations

"In this episode, we explore how AI is revolutionizing prior authorization and claims processing in healthcare payer organizations. From eliminating manual bottlenecks to complying with CMS-0057-F, learn how intelligent automation is driving faster approvals, lower costs, and better patient outcomes."

CMS-0057-F and Medicare Advantage Prior Authorization changes
Deep dive into CMS-0057-F Changes

"In this episode, we break down the new CMS-0057-F Final Rule and what it means for Medicare Advantage plans. From faster prior authorization decisions to mandatory FHIR-based APIs, we cover the biggest changes, the 2026–2027 compliance deadlines, and the operational and technical steps plans need to take. Whether you're on the product, compliance, or engineering team, this is your guide to understanding what's coming—and how to stay ahead of it."

HIPAA-compliant, AES encryption, and role-based access control to ensure your data is secure.

Built for enterprises—handle millions of requests with zero downtime.