Workflow guide · 47 products · 5 workflows
Prior Authorization, Referrals & Faxes
The paperwork that moves between practices and payers — authorization requests, referral packets, and the fax machines they still travel by.
What the software can do
- Detect whether an order needs prior authorization, payer by payer, before it holds up care.
- Assemble the request — pull supporting documentation from the chart, complete payer forms, and submit through portals or clearinghouses.
- Check authorization status by portal and by phone, without staff sitting on hold, and chase what has stalled.
- Read inbound faxes and referral packets: classify them, extract the data, match the patient, create the referral or order in the EHR, and flag what’s missing.
- Route accepted referrals to scheduling, so the loop closes with a booked visit instead of a stack of paper.
What stays human
Medical-necessity judgment and complex appeals stay clinical, and staff still work the exception queue — unusual payers, missing documentation, portals that changed last week. Across the census, requirement detection and status checking are maturing faster than complex medical-necessity work.
Automation levels: L0 analytics only · L1 assistant — drafts and suggests · L2 partial — completes meaningful steps · L3 exception-based — completes routine cases and sends exceptions to people · L4 near-autonomous — none validated in this census.
Products shown on this page have the strongest public evidence in the census; every product is in the directory.
Prior Authorization · 19 products
The census’s largest combined opportunity across labor, patient access, denials, and revenue. Requirement detection and status automation are maturing quickly; complex medical-necessity appeals remain human.
| Product | What it actually does | What stays human | Level | Fits |
|---|---|---|---|---|
| AscertainAscertain AI Agents / Touchless Prior Authorization | Executes referrals, eligibility checks, payer communications, documentation and care-coordination tasks across existing systems, with exceptions routed to case managers. | Case managers handle clinical judgment, complex payer cases and exceptions. | L3 | Medium to enterprise |
| Humata HealthHumata Prior Authorization Automation | Determines authorization needs, assembles clinical evidence, prepares and submits requests, tracks status and routes exceptions; payer-side collaboration can return decisions faster. | Staff handle clinical exceptions, payer escalation, denied cases and attestation. | L3 | Medium to enterprise |
| PlenfulAI Intake and Prior Authorization Suite | Extracts referrals and clinical documents, creates authorization work, submits and tracks requests, and automates specialty-pharmacy or infusion back-office reconciliation. | Staff manage clinical exceptions, denials and unsupported documents. | L3 | Medium to enterprise |
| Develop HealthAI Prior Authorization | Checks benefits, extracts chart evidence, fills and submits medication authorization forms, follows status and prepares appeals through EHR and payer connections. | Staff review exceptions, sign clinical statements and handle denials or unsupported payers. | L2 | Small to large |
| RxLightningSpecialty Medication Enrollment | Digitizes enrollment for specialty therapies, collects data and documents, and coordinates benefit, PA and assistance steps. | Staff manage clinical exceptions, signatures, appeals and assistance-program details. | L2 | Small to large |
| AbridgeAbridge + Availity Real-Time Prior Authorization | Uses encounter conversation context to surface payer documentation requirements and is being integrated with Availity FHIR utilization-management services to support authorization review and submission during the visit. | Clinicians validate documentation and orders; staff or connected workflows complete exceptions and payer interactions. | L1 | Large to enterprise |
Referral Intake · 10 products
Turns inbound referral packets — usually faxes — into classified, patient-matched, schedulable work in the EHR, and flags missing items.
| Product | What it actually does | What stays human | Level | Fits |
|---|---|---|---|---|
| Insight HealthClinical AI Agents / MagicDocs | Turns fax/email/upload referral packets into classified structured data, matches patients, flags missing items, creates EHR work and supports scheduling, authorization and documentation agents. | Staff review exceptions and perform clinical judgment. | L3 | Small to large |
| TennrTennr Patient Orchestration | Receives faxes/portal orders, splits and classifies packets, extracts demographics/orders, detects missing items, creates or updates charts, follows up with senders/patients and drives scheduling. | Referral staff handle low-confidence documents, clinical acceptance and exceptions. | L3 | Medium to enterprise |
Referral Management · 9 products
Tracks outbound referrals and their status. True closed-loop follow-through, and the economics of referral sources, remain underdeveloped across the market.
| Product | What it actually does | What stays human | Level | Fits |
|---|---|---|---|---|
| Switchboard, MDReferral and Contact Center Platform | Classifies referrals/calls/voicemails/faxes/messages, creates or updates patients in athenahealth, routes work, and uses AI voice/SMS to schedule and track conversion. | Staff handle exceptions, clinical routing and relationship management. | L3 | Medium to large |
| Valerie HealthValerie Referral Automation | Ingests referrals and documents, structures data, finds missing information, creates scheduling work and tracks referral conversion for independent specialty groups. | Practice staff approve complex/clinical referrals and exceptions. | L2 | Medium to large |
Fax Automation · 6 products
OCR alone is not the product. Value appears when documents are classified, matched to patients, entered, routed, and turned into completed work.
| Product | What it actually does | What stays human | Level | Fits |
|---|---|---|---|---|
| MedsenderMedsender AI Fax, Referral and Phone Automation | Reads/classifies inbound faxes, matches or creates patients, routes documents, starts referral workflows, schedules and sends outbound fax/phone follow-up; routine cases can run to exceptions. | Staff review low-confidence matches and complex referrals/calls. | L3 | Small to large |
| eClinicalWorksImage AI Assistant | Classifies incoming faxes, predicts the matching patient and document type, routes the image and asks staff to review/approve attachment in eClinicalWorks. | Staff review and approve the suggested patient/document match. | L2 | Small to large |
Intelligent Document Processing · 3 products
General document extraction applied to practice paperwork — reads, classifies, and structures documents so systems and people act on data instead of PDFs.
| Product | What it actually does | What stays human | Level | Fits |
|---|---|---|---|---|
| 314e CorporationDexit | Ingests fax/scan/email/API documents, classifies 150+ document types, extracts patient/payer/diagnosis data, routes work and writes structured data to the EHR; low-confidence cases go to review. | Staff review low-confidence documents and clinical exceptions. | L2 | Medium to enterprise |
See all 3 Intelligent Document Processing products in the directory →
Before you buy
- What share of authorizations completes without a human touch — and what is the denominator?
- Which of your payers and portals does it cover today, and what happens when a portal changes?
- Does extracted referral data write back into your EHR, or into a separate queue your staff copies from?
- How are urgent authorizations flagged and escalated?
- Who owns the error when a missed authorization becomes a denied claim?