# Prior Authorization Automation Solutions | AI Agents | RPA Canonical: https://www.flobotics.io/agents/prior-authorization-automation Published: 2026-02-26 Updated: 2026-02-26 --- [Home](https://www.flobotics.io/)/[What we do](https://www.flobotics.io/what-we-do)/Prior authorization Workflows we automate # Prior Authorization Automation We gather the information for prior authorization requests, fill payer forms, and submit the supporting documents. The automation checks for updates and saves them in your systems. Your team handles missing information and cases that need review. [Discuss your workflow →](https://www.flobotics.io/contact)[See client results](#results) Illustration of a prior authorization run. Three new orders are in the queue. For two, the automation pulls the order and insurance details, attaches the clinical note, fills the payer form, submits the request and saves the confirmation number and time. The third is missing the required clinical note, so it goes to staff review before submission. The example ends with 2 submitted and 1 needing a clinical note. No payer decision is shown. Prior authorization submission - Gather - Prepare - Submit - Follow up Authorization queue · new orders - A. RiveraOrder 4471 · MRI, lumbar spineSubmitted · confirmation saved - J. OkaforOrder 4472 · CT, chestSubmitted · confirmation saved - M. ChenOrder 4473 · Sleep studyStaff review · clinical note missing 2 submitted · 1 needs a clinical note Current request · A. Rivera OrderOrder 4471 PayerLakeshore PPO Request →Payer portal← Confirmation Patient & insurancePulled Clinical noteAttached Payer formFilled ConfirmationPA-55821 · 10:42 Confirmation saved to the order · next check scheduled Example with made-up patients. Submission is not a payer decision. PauseReplay Client result · PTCoA ## How PTCoA automated prior authorization submissions PTCoA's team prepared requests across several payer portals. We built automation to transfer order details, submit requests, and save confirmations. A separate follow-up process checks for payer updates and sends cases needing attention to staff. [Read the PTCoA case study →](https://www.flobotics.io/case-studies/85-faster-submissions-8-ftes-saved-prior-authorization-automation) Measured results 10–15 min →to 1–2 minper authorization packet submission 8+ FTEof staff capacity freed ~11% →to <1%submission error rate Results from PTCoA's project. Submission time is separate from the time a payer takes to decide. A genetic diagnostic lab cut handling time from 8–12 minutes to under 1 minute by moving order details and documents from its lab system into an authorization portal. [Read the lab case study →](https://www.flobotics.io/case-studies/90-faster-packet-submissions-prior-authorization-automation) Explore our [laboratory automation workflows](https://www.flobotics.io/who-we-help/laboratories) for related document and payer-portal tasks. What we automate ## The tasks behind a prior authorization request. Each request involves gathering information, preparing documents, submitting a form, and checking for an answer. These are the tasks we automate. - 01Gather Pull the information already recorded for the order. - Find new orders or requests in your work queue. - Pull patient, insurance, provider, and service details from your systems. - Collect the available clinical notes and other required documents. - 02Prepare Check the request against the payer's requirements. - Check authorization and document requirements where the payer makes them available. - Fill the required fields using the information on the order. - Flag missing documents, conflicting details, or questions needing clinical review. - 03Submit Send the request and keep its confirmation. - Submit through the supported payer connection or portal. - Attach the required documents for the right patient and order. - Save the confirmation number, submitted packet, and submission time. - 04Follow up Check what changed and record the answer. - Check open requests on an agreed schedule. - Save payer decisions, authorization details, and validity dates when returned. - Send information requests, denials, and unresolved cases to your staff. We set up the workflow for your systems, payers, and rules. Your team handles the cases that need a person. The payer decides whether to approve a request. An approval does not guarantee that the claim will be paid. Is it a good fit? ## Prior authorization automation usually pays off when most of these are true. - Your team prepares many authorization requests each week. - Staff copy order details and upload the same documents into payer portals. - Someone checks pending requests repeatedly for updates. - Most requests follow known steps, and you know which cases need clinical review. What affects your savings - How many requests you submit each month - How long preparation, submission, and follow-up take by hand - Which payer connections and portals are available - How often documents are missing or clinical review is needed - What it costs to build and maintain The return is different for every organization. Schedule a call and we'll give you a quick, honest estimate of whether it's worth it for yours. [Schedule a call →](https://tidycal.com/team/flobotics/flobotics-intro-call-w) How prior authorization automation works with your systems ## The automation moves requests between your systems and payer portals. Your staff keep using the systems they know. We use a direct connection where one is available, or UiPath and Python to work with portals and desktop apps. AI can read documents and payer messages. Questions that need clinical judgment go to your team. Example of the automation between three places. It reads new orders from the EHR or lab system, enters the patient details and attachments in the payer portal, submits the request and saves the confirmation back to the order. The second request stays pending. The third order is missing its clinical note, so it goes to the staff review queue before submission. Later, a payer update approves the first request, and the authorization number and dates are saved. Your EHR or lab system · authorization queue OrderPatientAuth no.Request 4471A. Rivera—Ready 4472J. Okafor—Ready 4473M. Chen—Ready Clinical note.pdf · on file Flobotics automation Your rulesUse order detailsCheck required attachmentsMissing note → staff Payer portal or direct connection Later payer update Member IDServiceAttachmentSubmit request Confirmation— Your staff · review queue M. Chen · order 4473Required clinical note is missing. Request it from the care team. No exceptions yet Monitored and maintained by us. We check the runs and update the workflow when payer portals or your systems change. Example with made-up patients. The connection and required documents differ by payer. Payer updates are shown at a later point in the example. PauseReplay Eligibility checks and claim submission are separate workflows. Authorization appeals can be added where the process and review rules are clear. Patient data (PHI) What happens to your patient data Your data is safe. Where it runsOn a machine you own: usually a virtual machine on your side, or your own AWS or Azure account. What we storeWe don't store patient data. The automation reads it, uses it and writes the result back. In the rare case PHI has to be in transaction data, it's encrypted. Who can access itOnly the developer who builds and maintains the automation. On your machine, you decide who else gets access. What we signA BAA before we see any patient data. AI runs on AWS, Azure or Google under BAAs, and your data isn't used to train models. [How we handle patient data →](https://www.flobotics.io/security)[Request our security policies →](https://trust.inc/flobotics) Related workflows ## The billing workflows around prior authorization. - 01[Eligibility & benefits](https://www.flobotics.io/agents/eligibility-check-automation)Check coverage before the visit and save the result in the patient record.~40 s per checkPTCoA · [Case study](https://www.flobotics.io/case-studies/100-roi-in-just-23-days-we-automated-eligibility-checks)→ - 02Prior authorizationPrepare and submit authorization requests, then check for updates.You are here - 03[Claims management](https://www.flobotics.io/agents/claims-management-automation)Prepare, submit, and track claims.98% less manual claim preparationGentem Health · [Case study](https://www.flobotics.io/case-studies/98-reduction-in-manual-claim-prep-claims-management-automation)→ - 04[Denials management](https://www.flobotics.io/agents/denials-management-automation)Prepare supported corrections and appeals, then track payer responses.Up to 300 resubmissions a dayPathGroup · [Case study](https://www.flobotics.io/case-studies/up-to-80-higher-throughput-in-rcm---denials-management-automation)→ [Explore revenue cycle management automation →](https://www.flobotics.io/rcm-automation) Talk to us ## Is automating your prior authorization work worth it? Book a 30-minute call with Karl, our CTO. If you'd rather write, send us a message. [Book a 30-minute call →](https://tidycal.com/team/flobotics/flobotics-intro-call-w)[Send us a message](https://www.flobotics.io/contact) 30-minute callKarl MielnickiCo-founder, CTO Walk me through how your team prepares and follows up on authorization requests. Within the first 15 minutes, we can usually tell whether automation makes sense. We'll discuss the work involved and what we'd need to estimate the cost. Karl