SolutionsHealthcarePrior Authorization Exception Review
by HumanAgent

Prior Authorization Exception Review

AI handles routine authorizations. A clinician reviews the ones that fall outside criteria.

Typical budget · $35–$150 per request

Volume and enterprise pricing available · you set the budget per task

The problem

Federal rules now require standard prior authorization decisions within seven days and urgent ones within seventy-two hours. Your AI clears the requests that match criteria cleanly. The ones that don't still need a clinician — and the clock is already running.

How it works

01

Submit your prior authorization request

Via form, API, or SDK. From any workflow or AI agent.

02

AI analyzes and flags

AI clears requests that match criteria cleanly, flags exceptions for clinical review

03

Human reviews what matters

Licensed clinical reviewer reviews flagged items within your SLA. Credential requirements vary by task.

04

Result + audit trail

Structured decision. SHA-256 audit hash. Tamper-proof record.

What the human reviewer does

Reviews requests that fall outside standard criteria

Evaluates supporting clinical documentation for completeness

Issues an approve, deny, or request-more-information decision within the regulatory window

Cites the specific criteria applied in the decision

Produces an attributed record with timestamp for the compliance file

Pricing

Typical budget · $35–$150 per request
  • You set the budget per task — operators choose what to accept
  • Volume pricing for recurring workflows
  • Enterprise agreements for committed volume
  • Operators earn 80% of the checkpoint budget
  • Auto-refund if the deadline is missed

Who reviews

Verified professionals matched to the Healthcare category

Credential requirements vary — some tasks require specific certifications, others are open to all verified operators

Every review includes a SHA-256 audit hash for verification

Preferred credential for this use case: Licensed clinical reviewer

Built with HumanAgent

This use case was built with the HumanAgent API. You can build your own version — customize the workflow, set your own pricing, integrate your own AI, and choose your operators.

Operator credential requirements vary by task. Some tasks are open to all verified operators.