Healthcare and Payer Operations

Prior Authorization Automation

Accelerating Prior Authorization Processing with AI-Driven Data Extraction and Workflow Automation

A healthcare platform managing prior authorization workflows faced delays due to fragmented data and manual validation processes. Key information such as patient details, eligibility, and provider data was often incomplete or inconsistent, slowing down decision-making and impacting care timelines. To address this, an AI-driven automation system was introduced to extract, structure, and validate data across authorization workflows.

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Challenge

Solution

The Outcome

The Challenge

The platform needed to accelerate prior authorization workflows while cutting delays caused by manual data handling and inconsistent information.

Incomplete and Fragmented Data

‍Prior authorization processes relied on data from multiple stakeholders, often resulting in missing or incorrect information. These inconsistencies delayed approvals and slowed down care delivery.

Manual Validation and Processing Delays

‍Reviewing and validating authorization documents required significant manual effort. This process increased errors and extended turnaround times for approvals.

The Solution

We built an automated system to extract, validate, and process prior authorization data with higher speed and accuracy.

AI-Based Data Extraction

‍Used OCR and large language models to extract and structure key data from unstructured documents.

Rule Engine for Validation

‍Developed a configurable rule engine to assess prior authorization data against specific medical and payer requirements.

Microservices Architecture

‍Transitioned from a monolithic system to microservices to improve flexibility, throughput, and performance.

Automated Testing Framework

‍Built unit, integration, and system testing to sustain system dependability across updates.

Automated Reporting

‍Generated structured PDF reports with clear validation outcomes to simplify review processes.

The Outcome

The healthcare platform now runs a faster and more dependable prior authorization system backed by automated workflows and structured data processing. This has cut delays and raised accuracy across the approval lifecycle.

Accelerated prior authorization processing by 3X, reducing delays and improving turnaround time for critical approvals.

Reduced manual effort and errors 70% through automated data extraction and validation workflows.

Sustained 95%+ data extraction accuracy across growing document volumes, supporting consistent performance as caseloads expanded.

We have been working with Entrans for the last two years and they have played a key role in building our solution. Their expertise and professionalism were evident throughout the development cycle, and we were very pleased with the final product. They have shown enormous skill and vast domain knowledge and their IT expertise is reliable and trustworthy. We would recommend Entrans for anyone looking for quality IT services, delivered in a professional manner

Nikolay Prokopiev

Chief Executive Officer

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