AI agents work prior auth, claims, denials, and payer follow-up inside the systems your team already uses. The decisions that need a person stay with your team.
One prior-auth submission
15 hrs
spent on prior auth per practice, per week
71%
employ at least one person exclusively for it
1 Pereira et al., “Prior Authorization in Total Joint Arthroplasty,” Journal of Arthroplasty (2023)
A prior-auth submission should take about five minutes. After the case is entered and the records uploaded, staff are often redirected to another portal or a phone line, and the same information has to be entered again until the request reaches the right channel.
The hardest cases are rarely the most clinically complex. They are the ones that bounce.
Nothing here is complicated on its own. The cost is that every stage asks a person to move the same information between systems that do not talk to each other, hundreds of times a week.
One case, across the systems your team already uses
EHR
Structured
PDFs & fax
Unstructured
Payer portal
Web UI only
Phone call
Human channel
EHR
Structured
The agent gathers the codes, pulls the supporting documentation, completes the payer-specific submission, and tracks it to a decision. Your team sees the result, not the round trip.
Patient data, orders, and codesare joined with supporting records.
Portal entry and payer callsare handled in the same workflow.
Status and confirmation detailsare returned automatically.
A Clicks agent gathers the patient information and supporting clinical documentation from the EHR and assembles a submission-ready packet. This is the same loop running behind every workflow on this page.
eClinicalWorks demo using fictional patient data in a test environment.
Check coverage, benefits, and patient responsibility with payers in real time
Compile clinicals and submit prior auth requests, then track them to approval
Generate clean claims and submit them to payers without manual touch
Identify root causes, draft appeals, and resubmit denied claims
Process ERAs and EOBs and reconcile payments across accounts
Complete and file payer and regulatory forms straight from the patient record
Filing, documentation, and coding errors
Not broken out in the report
Medical necessity and similar reasons
Most denials are a paperwork dispute, not a clinical one: timely filing, incorrect documentation, incomplete claims, coding errors. Clinical disagreements are at most 1%.
That explains why a denial happens, not what happens next. Nearly a quarter of denied claims are never recovered, and 95% of those were avoidable.2
Payers allow 30 to 90 days to appeal. So practices triage, the largest claims get worked first, and routine denials run out of time.
2 MGMA, citing the Change Healthcare Revenue Cycle Denials Index
Example denial processed start to finish by AI in minutes
A $412 imaging claim denied for missing documentation, from the denial notice through to payment.
Payer denies the claim
Remittance
Claim 4471
Documentation missing · $412.00
Agent finds the reason
Reason found
Policy MSK-14
6 weeks conservative care required first
Agent pulls the evidence
› ChartAgent files the appeal
Submitted
Fax and phone also supported
Confirmation A-8842
Payer pays the claim
Remittance
Claim 4471
Posted to the ledger
Every denial gets the treatment it deserves. The $412 imaging claim no longer waits behind the $40,000 surgical case, and the surgical case still gets the extra scrutiny its value warrants.
Diagnosis, treatment selection, and medical necessity stay with qualified clinicians.
Some denials need a physician to make the case directly. That call is your surgeon's.
The agent never contacts a patient about a bill or a denial. Your team stays their point of contact.
The strongest first candidates satisfy five criteria. If a workflow meets all five, it will usually pay for itself before the rollout is finished.
Connect via API or MCP, or let Clicks operate directly through your existing UIs. No custom integrations needed.
Each stage above is covered in full in one of our guides.
No risk, no commitment. We prove value before you pay.