Auto Prior Auth

JSON twin: https://www.healthaidb.com/software/auto-prior-auth.json

Company Name

GenHealth

Product URL

https://genhealth.ai/product/automated-prior-authorization/provider-submission

Company URL

https://genhealth.ai

Categories

• clinical Care
• administrative Operations
• diagnostic Support
• patient Facing
• prior Authorization
• Clinical
• Administrative
• Diagnostic
• Prior Authorization Management

Summary

GenHealth.ai's Auto Prior Auth is an AI-driven solution that automates the prior authorization process for healthcare providers and insurers, enhancing efficiency and accuracy.

Description

GenHealth.ai's Auto Prior Auth system automates the prior authorization process for healthcare providers and insurers with auditable, explainable decisions. It uses AI to extract patient data from various sources, including faxes, HL7v2, and call center transcripts. The system ingests medical policies and generates decision recommendations based on plan-specific workflows. It provides early abuse detection, individual risk assessments, and provider gold card recommendations.

Api Available

yes

Certifications

• FDA 510(k)
• CE/MDR
• ONC-ATCB
• ISO 9001
• ISO 13485
• ISO 14001
• ISO 45001
• ISO 50001
• ISO 22301
• ISO 27001

Company Founding

2023

Company Offices

• United States

Compliance

• HIPAA
• SOC 2 Type 2
• SOC 2 Type 1
• HITRUST CSF
• GDPR
• HITECH
• ISO 27001
• ISO 27018
• ISO 27032
• ISO 27035

Customers

• Health Plan

Data Residency

US-only

Data Standards

• FHIR
• HL7v2
• CPT
• ICD-10
• HCPCS
• SNOMED CT
• LOINC
• ICD-9
• CDA
• X12

Deployment Model

• SaaS

Features

• Automated prior authorization submission
• AI-powered autofill of prior authorization forms
• Integration with electronic health records (EHRs)
• Fax-based submission to payers
• Real-time tracking of prior authorization status
• Automated generation of cover letters for submissions
• Support for multiple payer policies
• Secure handling of patient data
• User-friendly interface for healthcare providers
• Compliance with healthcare regulations

Id

SW1393

Integration Partners

• Epic
• Cerner

Integrations

• eClinicalWorks
• Athenahealth
• Brightree
• NikoHealth
• Bonafide
• Fax systems
• HL7v2
• FHIR
• Da Vinci FHIR APIs
• EHR systems

Languages Supported

• English

Last Updated

2025-10-11

License

commercial

Market Segment

• enterprise
• smb

Optional Modules

• Advanced analytics
• Customizable workflows
• Integration with additional EHR systems
• Multi-language support
• Mobile application
• Reporting and dashboards
• Audit trails
• User role management
• Data export capabilities
• Patient portal integration

Os Platforms

• Web

Pricing Details

Contact vendor for pricing information.

Pricing Model

subscription

Privacy Features

• Business Associate Agreement (BAA)
• Consent management
• Data anonymization
• Data minimization
• Data masking
• Access controls
• Data retention policies
• Data segregation
• Data classification
• Data integrity checks

Product Code

SW1393

Product Name

Auto Prior Auth

Ratings

• 4.5/5 on G2
• 4.5/5 on Elion

Regions Available

• United States

Related Urls

• https://elion.health/products/genhealth-ai-auto-prior-auth

Release Year

2023

Security Features

• Encryption
• Role-Based Access Control (RBAC)
• Single Sign-On (SSO)
• Audit logs
• Two-Factor Authentication (2FA)
• Data Loss Prevention (DLP)
• Secure File Transfer Protocol (SFTP)
• Virtual Private Network (VPN)
• Intrusion Detection System (IDS)
• Intrusion Prevention System (IPS)

Specialties

• Radiology
• Cardiology
• Orthopedics
• Neurology
• Oncology
• Pediatrics
• Dermatology
• Psychiatry
• Obstetrics
• Gynecology
• Urology
• Gastroenterology
• Pulmonology
• Endocrinology
• Rheumatology
• Infectious Disease
• Hematology
• Allergy And Immunology
• Nephrology
• Otolaryngology

Support Channels

• email
• phone
• chat
• ticketing
• community
• 24x7

System Requirements

Target Users

• clinicians
• nurses
• admins
• payers

Training Options

• documentation
• webinars
• live_online
• onsite
• certification

Type

product

User Reviews

• GenHealth.ai's Auto Prior Auth system automates the prior authorization process for healthcare providers and insurers with auditable, explainable decisions.

Version

1.0

Alternatives

See related products

Canonical JSON

{
  "product_name": "Auto Prior Auth",
  "company_name": "GenHealth",
  "product_url": "https://genhealth.ai/product/automated-prior-authorization/provider-submission",
  "company_url": "https://genhealth.ai",
  "related_urls": [
    "https://elion.health/products/genhealth-ai-auto-prior-auth"
  ],
  "product_code": "SW1393",
  "summary": "GenHealth.ai's Auto Prior Auth is an AI-driven solution that automates the prior authorization process for healthcare providers and insurers, enhancing efficiency and accuracy.",
  "description": "GenHealth.ai's Auto Prior Auth system automates the prior authorization process for healthcare providers and insurers with auditable, explainable decisions. It uses AI to extract patient data from various sources, including faxes, HL7v2, and call center transcripts. The system ingests medical policies and generates decision recommendations based on plan-specific workflows. It provides early abuse detection, individual risk assessments, and provider gold card recommendations.",
  "categories": [
    "clinical Care",
    "administrative Operations",
    "diagnostic Support",
    "patient Facing",
    "prior Authorization",
    "Clinical",
    "Administrative",
    "Diagnostic",
    "Patient-facing",
    "Prior Authorization Management"
  ],
  "market_segment": [
    "enterprise",
    "smb"
  ],
  "target_users": [
    "clinicians",
    "nurses",
    "admins",
    "payers"
  ],
  "specialties": [
    "Radiology",
    "Cardiology",
    "Orthopedics",
    "Neurology",
    "Oncology",
    "Pediatrics",
    "Dermatology",
    "Psychiatry",
    "Obstetrics",
    "Gynecology",
    "Urology",
    "Gastroenterology",
    "Pulmonology",
    "Endocrinology",
    "Rheumatology",
    "Infectious Disease",
    "Hematology",
    "Allergy And Immunology",
    "Nephrology",
    "Otolaryngology"
  ],
  "regions_available": [
    "United States"
  ],
  "languages_supported": [
    "English"
  ],
  "pricing_model": "subscription",
  "pricing_details": "Contact vendor for pricing information.",
  "license": "commercial",
  "company_offices": [
    "United States"
  ],
  "company_founding": "2023",
  "deployment_model": [
    "SaaS"
  ],
  "os_platforms": [
    "Web"
  ],
  "features": [
    "Automated prior authorization submission",
    "AI-powered autofill of prior authorization forms",
    "Integration with electronic health records (EHRs)",
    "Fax-based submission to payers",
    "Real-time tracking of prior authorization status",
    "Automated generation of cover letters for submissions",
    "Support for multiple payer policies",
    "Secure handling of patient data",
    "User-friendly interface for healthcare providers",
    "Compliance with healthcare regulations"
  ],
  "optional_modules": [
    "Advanced analytics",
    "Customizable workflows",
    "Integration with additional EHR systems",
    "Multi-language support",
    "Mobile application",
    "Reporting and dashboards",
    "Audit trails",
    "User role management",
    "Data export capabilities",
    "Patient portal integration"
  ],
  "integrations": [
    "eClinicalWorks",
    "Athenahealth",
    "Brightree",
    "NikoHealth",
    "Bonafide",
    "Fax systems",
    "HL7v2",
    "FHIR",
    "Da Vinci FHIR APIs",
    "EHR systems"
  ],
  "data_standards": [
    "FHIR",
    "HL7v2",
    "CPT",
    "ICD-10",
    "HCPCS",
    "SNOMED CT",
    "LOINC",
    "ICD-9",
    "CDA",
    "X12"
  ],
  "api_available": "yes",
  "system_requirements": "",
  "compliance": [
    "HIPAA",
    "SOC 2 Type 2",
    "SOC 2 Type 1",
    "HITRUST CSF",
    "GDPR",
    "HITECH",
    "ISO 27001",
    "ISO 27018",
    "ISO 27032",
    "ISO 27035"
  ],
  "certifications": [
    "FDA 510(k)",
    "CE/MDR",
    "ONC-ATCB",
    "ISO 9001",
    "ISO 13485",
    "ISO 14001",
    "ISO 45001",
    "ISO 50001",
    "ISO 22301",
    "ISO 27001"
  ],
  "security_features": [
    "Encryption",
    "Role-Based Access Control (RBAC)",
    "Single Sign-On (SSO)",
    "Audit logs",
    "Two-Factor Authentication (2FA)",
    "Data Loss Prevention (DLP)",
    "Secure File Transfer Protocol (SFTP)",
    "Virtual Private Network (VPN)",
    "Intrusion Detection System (IDS)",
    "Intrusion Prevention System (IPS)"
  ],
  "privacy_features": [
    "Business Associate Agreement (BAA)",
    "Consent management",
    "Data anonymization",
    "Data minimization",
    "Data masking",
    "Access controls",
    "Data retention policies",
    "Data segregation",
    "Data classification",
    "Data integrity checks"
  ],
  "data_residency": "US-only",
  "customers": [
    "Health Plan"
  ],
  "user_reviews": [
    "GenHealth.ai's Auto Prior Auth system automates the prior authorization process for healthcare providers and insurers with auditable, explainable decisions."
  ],
  "ratings": [
    "4.5/5 on G2",
    "4.5/5 on Elion"
  ],
  "support_channels": [
    "email",
    "phone",
    "chat",
    "ticketing",
    "community",
    "24x7"
  ],
  "training_options": [
    "documentation",
    "webinars",
    "live_online",
    "onsite",
    "certification"
  ],
  "release_year": "2023",
  "integration_partners": [
    "Epic",
    "Cerner"
  ],
  "id": "SW1393",
  "slug": "auto-prior-auth",
  "type": "product",
  "version": "1.0",
  "last_updated": "2025-10-11",
  "links_json": {
    "self": "https://www.healthaidb.com/software/auto-prior-auth.json"
  }
}