Overview

skyAuth is an agentic prior authorization platform that automates the entire PA lifecycle — from intake and eligibility verification through submission, payer follow-up, and decision writeback. It connects directly with major payers and EHR systems, uses AI to gather clinical evidence and complete payer-specific forms, and gives care teams real-time visibility through a dashboard and analytics suite.

How It Works

1. Intake & Data Extraction

   Tasks are pulled automatically from your EHR portal. Patient demographics, clinical notes, procedure codes, and supporting documents are extracted and validated. A confidence score indicates data completeness before the workflow proceeds, flagging any missing information for review.

2. Eligibility Verification

   skyAuth checks the appropriate payer portal to determine whether prior authorization is required, not required, or already decided — eliminating unnecessary submissions and ensuring your team only works on cases that truly need authorization.

3. PA Submission

   When authorization is required, skyAuth assembles the complete clinical package — including AI-generated clinical letters, completed payer-specific forms, and supporting documents — and submits directly to the payer. Instant decisions are captured immediately.

4. Payer Follow-Up

   For pending cases, skyAuth automatically monitors payer portals on a recurring schedule, checking for status updates so your team does not have to log in and check manually.

5. Decision & EHR Writeback

   The final outcome — approved, denied, or not required — is captured and written back to your EHR automatically, closing the loop without manual data entry.

AI at Every Step — skyAuth uses AI to read clinical charts, extract required data fields, detect whether PA is needed, pre-fill payer-specific forms, generate medical necessity letters, answer payer questionnaires, and upload clinical documents automatically.

What It Does

Full Workflow Orchestration

Orchestrates the complete prior auth workflow: eligibility checks, criteria detection, gathering clinical evidence, form completion, submission to payers, and status monitoring.

AI-Powered Automation

Uses AI to read charts, extract required fields, prefill payer-specific forms, and generate clinical letters.

Enterprise Scale

Supports multi-tenant architectures so large IDNs and groups can run high-volume PA at scale with isolated data and configuration per organization.

EHR Integration

Bi-directional integration with ModMed (Modernizing Medicine). Reads patient data, clinical notes, and documents from your EHR and writes back authorization decisions and status updates automatically.

Analytics & Reporting

Real-time dashboard showing status distribution, workflow funnel, daily trends, top denial reasons, high-denial CPT codes, and date range filtering for targeted analysis.

Document Management

View, edit, and manage clinical letters and PA forms directly within the platform. AI-generated medical necessity letters can be reviewed and refined before submission.

Smart Safeguards

Duplicate detection prevents redundant PA requests with configurable handling (block, warn, or allow). Confidence scoring flags cases with missing or incomplete information before submission.

Manual Controls

Create PA tasks on demand by entering a patient MRN and procedure code. Mark any task as completed at any stage. Retry failed submissions with one click.

Why It’s Needed in the Market

Prior auth is one of the most painful, labor-intensive workflows in healthcare, contributing heavily to clinician burnout and delayed patient care. Many solutions only digitize forms without truly automating data gathering and reasoning.

skyAuth is an AI-first, agentic PA stack that connects directly with payer portals and EHR systems to automate data gathering, eligibility checks, submission, and follow-up — unlocking up to 30% more care capacity by slashing manual effort in PA and related back-and-forth.

Key Metrics It Moves

Care Capacity

Up to 30% more care capacity by reducing time spent on PA.

Time-to-Authorization

Fewer days from order to decision via automated data prep and submission.

Denial Rate

Improved completeness and alignment with payer criteria can lower avoidable denials.

Administrative FTE Load

Fewer staff hours per case through end-to-end automation of data extraction, eligibility checks, submissions, and status monitoring.

Unnecessary Submissions Avoided

Automated eligibility checks identify cases where PA is not required or has already been decided, eliminating wasted effort on submissions that were never needed.

Real-Time Visibility

Dashboard and analytics give leadership immediate insight into PA volume, bottleneck stages, denial patterns, and team workload for data-driven operational decisions.

Supported Integrations

Payer Integrations

United Healthcare (UHC), CareOregon, PacificSource, Availity clearinghouse, and OneHealthPort. The platform is designed to onboard additional payers as your network grows.

EHR Integrations

ModMed (Modernizing Medicine) with bi-directional integration — read patient data, clinical notes, and documents; write back authorization decisions and status updates automatically.

Enterprise Ready

Multi-Tenant Architecture

Supports large health systems, IDNs, and multi-practice groups with isolated data and configuration per organization.

Scalable Automation

Distributed processing handles high-volume PA workloads across multiple payer portals simultaneously.

Role-Based Access

Configurable user roles and permissions to match your organization’s structure.

Notifications & Export

Email and SMS alerts keep staff informed of status changes and required actions. Export PA data for reporting, compliance, and integration with other tools.