Every payer wants the same clinical story in a different envelope. The agent reads the note, pulls the codes, fills that payer's form, attaches the documentation their policy actually requires, and submits — then tracks the determination and flags what needs a peer-to-peer.
Spec sheet
ModelClaude Sonnet
Runs onCustom API
Avg cost / run$0.14
Avg runtime~2m
Setup time1.5 hrs
Runs logged14,800
What a run looks like
Reads the order and notePulls diagnosis, procedure codes, and the clinical narrative from the chart.
Loads the payer policyMatches the CPT to that payer's current medical policy and its evidence checklist.
Builds the packetFills the form, attaches only the documents the policy names, flags any missing item before submission.
Submits and tracksPortal, Availity, or fax depending on the payer; polls for determination daily.
Flags escalationsDenials come back with the policy paragraph that was cited and a drafted peer-to-peer request.
Wired to
AthenahealthAvailityFax (SRFax)Google Drive
What you’ll need
EHR with API access (Athena, Epic, or eCW)
Payer portal credentials
A clinician to approve submissions — the agent does not submit unattended by default
Reviews 62 ratings
Sonia MarekPractice manager, orthoJul 2026
Auth turnaround went from 9 days to 3. The missing-documentation flag before submission is the whole game.
Dr. Owen CastellanosOrthopedic surgeonJun 2026
It writes a better peer-to-peer request than I do at 6pm.
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